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Penetrating knife injury to the heart
H Furukawa1, K Tsuchiya, K Ogata
1Department of Cardiovascular Surgery, Yamanashi Prefectural Central Hospital, Japan.
Insights
This case report details the successful surgical repair of a penetrating cardiac injury caused by a knife. Prompt resuscitation and emergency surgery were key to the patient's recovery and discharge.
Area of Science:
- Cardiology
- Trauma Surgery
- Emergency Medicine
Background:
- Penetrating cardiac injuries require immediate medical attention.
- Timely surgical intervention is crucial for survival in cases of cardiac tamponade and hemothorax.
Observation:
- A 39-year-old male presented with a self-inflicted stab wound to the left anterior chest.
- The patient exhibited unstable vital signs, left hemothorax, and moderate cardiac tamponade.
- A knife was lodged in the chest wall, complicating the injury.
Findings:
- Emergency chest drainage yielded 2500 ml of blood, relieving tamponade.
- Median sternotomy revealed injuries to the right ventricular outflow tract, left lung, and intercostal vessels.
- Successful surgical repair of cardiac and vascular structures was achieved using cardiopulmonary bypass and pledgeted sutures.
Implications:
- This case highlights the efficacy of rapid resuscitation and emergency surgical management in treating severe penetrating cardiac trauma.
- Successful outcomes are achievable even with complex injuries involving cardiac, pulmonary, and vascular structures.
- Prompt surgical repair can lead to favorable patient recovery and discharge.
Abstract:
A 39-year-old man attempted to kill himself using a small knife to penetrate the left anterior chest wall because of trouble at work and with his girlfriend. On arrival at the emergency room, his consciousness was not clear and vital signs were unstable. The knife remained vertically located in the left anterior chest wall. A large left hemothorax was identified by chest X-ray, and moderate cardiac tamponade was detected by echocardiography. Left-sided chest drainage was performed by inserting a chest drainage tube, and about 2500 ml of hemorrhagic effusion was drained. An emergency operation was performed to relieve the cardiac tamponade and repair the penetrating cardiac injury. About an hour after arrival at the emergency room, a median sternotomy was performed in the operating room. The knife had injured the surface of the right ventricular outflow tract, the left lung, and the 3rd intercostal artery and vein. Cardiopulmonary bypass was immediately prepared for the repair of the cardiac injury. The wounds were successfully repaired with pledgeted sutures under cardiac beating. The postoperative course was uneventful with no sign of infection. The patient was discharged at 9 days after the operation. Here we have reported a case of successful surgical repair of a penetrating knife injury to the heart, which was managed by immediate resuscitation and emergency surgery.