Injuries To The Cardiac Valves And Coronary Arteries

Blunt and penetrating trauma can result in injuries to the coronary arteries or cardiac valves. The left anterior descending artery (LAD), because of its more anterior location, is the most susceptible to injury. Injuries to the distal third of the LAD can generally be managed with ligation of the vessel. More proximal injuries generally require cardiopulmonary bypass and reverse saphenous vein grafting to the distal LAD (Fig. 19.11a-b). Penetrating injuries to the heart may result in valvular injuries which may be overlooked in the haste of repairing an external cardiac injury. Transesophageal echocardiography is invaluable in assessing valvular function in the presence of penetrating cardiac trauma. Blunt rupture of cardiac valves has also been reported, with successful repair performed.

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