TITLE:
Myocardial Ischemia Following Shrapnel Epicardiac Injury 16 Years Earlier: Case Report
AUTHORS:
Jaffar S. Shehatha, Dara M. Mohialdeen, Abdulsalam Y. Taha, Abdulsalam Y. Taha
KEYWORDS:
Coronary Artery; Late Injuries; Epicardiac; Myocardial Ischemia; Repair; Revascularization
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.3,
March
6,
2014
ABSTRACT: Coronary artery injuries are uncommon. Acute
injuries of major coronary vessels, particularly the left anterior descending
artery (LAD), are life-threatening because of the significant cardiac dysfunction
that ensues and usually requires repair or bypass. In contrast, late
presentation of missile coronary artery injuries has been sporadically reported
in the literature. Herein we present a 32-year-old lady from Sulaimania, Iraq with multiple
shrapnel injuries 16 years earlier presented recently with severe anterolateral
myocardial ischemia unresponsive to medical treatment. Coronary angiography and
surgical exploration revealed shrapnel compressing the LAD. The patient
responded very well to shrapnel extraction and coronary artery
revascularization (off pump left internal mammary artery—LIMA—to LAD
anastomosis). The management of this patient is discussed with review of
relevant literature. It is concluded that long-standing shrapnel close to a
major coronary artery may incur an external trauma initiating a localized
arteriosclerosis with an extremely long time interval from injury to the onset
of symptoms of myocardial ischemia.