CPB-Supported Emergency Surgery for Complex Penetrating Cardiac Injury | The Second Hospital of Jilin University

Baseline Characteristics A 43-year-old male patient sustained a penetrating chest injury from a high-speed 2cm metallic fragment due to an accident. Upon admission, the patient presented with hemorrhagic shock (BP 80/40 mmHg) and ultrasound-confirmed cardiac tamponade.

Anatomical Dilemma Intraoperative exploration confirmed a highly complex trauma trajectory: the fragment sequentially penetrated the chest wall, lacerated the lung, pierced the pericardium, and directly entered the pulmonary artery via the lateral wall of the ascending aorta. Deeply embedded between the core great vessels and severely obscured by damaged tissue and hematoma, the exact location of the foreign body could not be identified through routine sternotomy and direct visual inspection. Blind exploration or forced extraction in a non-direct visual field carried an extreme risk of instant aortic or pulmonary artery avulsion, leading to irreversible fatal hemorrhage.

Surgical Intervention & Technical Details To address these complex anatomical conditions, the surgical team implemented the following core technical interventions:

• Intraoperative Multimodal Imaging Localization: Bypassing blind exploration in the surgical blind spot, the team immediately integrated intraoperative fluoroscopy with Transesophageal Echocardiography (TEE) for real-time linkage. This cross-validation precisely identified the 3D spatial location of the metallic fragment within the pulmonary artery and its anatomical relationship with adjacent great vessels.
• Prophylactic Cardiopulmonary Bypass (CPB) Establishment: To mitigate the risk of great vessel rupture, CPB was decisively established. By achieving complete hemodynamic takeover and cardiac unloading, CPB provided a safe, bloodless surgical field.
• Precise Dissection & In-situ Repair: Supported by CPB, the surgeons safely dissected the damaged vascular tissue, precisely extracted the lethal fragment from the pulmonary artery, and sequentially completed the anatomical in-situ repair of the pulmonary artery, aorta, pericardium, and lung tissue.

Clinical Summary This case demonstrates that traditional blind exploration is highly hazardous when managing complex Penetrating Cardiac Trauma (PCT) involving core great vessels. An intervention strategy combining "precise localization via intraoperative multimodal imaging (TEE + Fluoroscopy)" with "hemodynamic support via prophylactic CPB" effectively prevents catastrophic intraoperative hemorrhage, providing a crucial safety window for foreign body extraction and meticulous vascular repair.