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Reprint requests: C. Clay Cothren, MD, FACS, Program Director, Surgical Critical Care Fellowship, Department of Surgery, Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204.
A 40-year-old woman sustained a stab wound to the left chest. Arriving in asystolic arrest, the patient
underwent an emergency department resuscitative thoracotomy that revealed a 2-cm laceration
to the right ventricle in proximity to the left anterior descending artery (LAD).
Cardiorrhaphy was performed during asystole; the patient regained pulses with open
cardiac massage and intracardiac epinephrine. Definitive repair was accomplished with
pledgeted sutures with care to avoid the LAD (Fig 1). Intraoperative auscultation with a sterile stethoscope revealed a holosystolic murmur.
Fig 1Intraoperative photo of the pledgeted repair (arrow) of the right ventricle.
