Penetrating cardiac
injuries are an increasing cause of traumatic deaths in urban areas. The management of these
injuries has undergone a transition from simple pericardiocentesis to cardiac ultrasound evaluation in the stable patient, and emergency
thoracotomy and repair of myocardial
wounds in the unstable patient in extremes. The incidence of traumatic coronary artery injury is not accurately known because not all victims are examined. With the improvement in emergency medical services, including speed of transportation of these patients, better
resuscitation, and knowledgeable use of cardiac ultrasound or emergency room
thoracotomy, more patients with coronary artery
injuries will survive and reach the operating room. The operative management of the injured coronary artery is dependant on the location of the injury and whether there is myocardial dysfunction. Distal
injuries with small
myocardial infarction should be treated by
ligation alone. Proximal injury and those
injuries associate with larger area of ischaemia or
infarction are best treated with
coronary artery bypass. The role of
cardiopulmonary bypass pump in these patients should be evaluated depending on the homodynamic stability of the patient. We present two cases of cardiac
stab wounds with transection of the left anterior descending (LAD), which were successfully managed. A literature review regarding the management of combined cardiac and coronary artery
injuries is also provided.