A 16-year-old man with no relevant morbid history.
He received a wound with white weapon for the third intercostal space.
Cardiac arrest was performed and an exploratory laparotomy was performed.
A hemopericardium and a heart wound of approximately 10 mm in length were found in relation to the right ventricular outflow tract.
It was sutured with 3-0 continuous polypropylene suture.
No other lesions were found.
The patient was discharged home on the fourth postoperative day.
On the 17th day of follow-up, a precordial thump was found and there was a continuous murmur in the mesocardium of 4/6 intensity.
Transesophageal echocardiography revealed a turbulent flow communicating the aortic root with the outflow tract of the right ventricle at 5 mm over the right coronary velum, with a maximum gradient of 90 mmHg, compatible with a right ventricular fistula.
Surgical closure was performed on the 18th day after the first intervention.
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Surgical procedure: The vertical medial approach was applied and adhesions were released.
A frémitus was found in the outflow tract of the right ventricle and was calculated by gas chromatography (Qp:Qs =1.5:1.
Using extracorporeal circulation at normothermia, with arterial cannulation in the ascending aorta and single venous cannulation, the heart was closed with anterograde crystalloid cardioplegia.
The fistula was exposed by endoscopy.
A 5 mm lesion was found on the valve plane and 2 mm on the left side of the right coronary ostium. A 5 mm linear lesion with a "plus" of dissection at its upper edge was found.
The lesion was repaired and fixed with separate 5-0 polypropylene sutures.
When the outflow of extracorporeal circulation was observed, the fomitus disappeared and Qp:Qs was recalculated with the shunt disappearance.
1.
Post-operative phase: The patient was discharged home without incidents.
The transthoracic echocardiogram on the fourth postoperative day showed a small residual fistula of the aorta to the right ventricle in the area where the lesion was located.
Expectant management was decided and the patient was discharged on the fourth postoperative day, asymptomatic and without murmur.
Three months after surgery, the transthoracic echocardiogram was within normal limits, with no dilatation of right cavities and no evidence of residual fistula.
At 18 months the patient is in functional capacity I, asymptomatic, without murmur and transthoracic echocardiography shows no significant findings.
