Successful Urgent Thoracotomy in a Patient with Penetrating Heart Injury - Case Report

Abstract

The case of a patient with a penetrating cardiac injury successfully treated by thoracotomy is reported. In a suicidal attempt, he suffered a self-inflicted thoracic stub wound penetrating the left ventricle. During transport to the hospital, he developed circulatory instability. He was admitted to the emergency department with no signs of life and bilateral non-responding mydriasis. Immediately, urgent anterolateral thoracotomy at the left 5 th rib was performed. The pericardium was opened, cardiac tamponade was evacuated and the stab wound in the right ventricle was sutured. The subsequent ventricular fibrillation was treated using defibrillation with an electric discharge of 200 J. After sinus rhythm had resumed, the patient was transferred to the operating theatre for the finishing of thoracic exploration. No more injury was found. Intermittent myoclonus had persisted since admission, and a CT scan showed diffuse cerebral oedema due to post-hypoxic brain damage. During the following hospitalisation, the patient underwent the SSEP examination (evoked potentials) and no signs of decortication were found. At four weeks after; injury, the patient was transported to his regional hospital he was afebrile, with stable circulation, spontaneous ventricular function and the GCS of 8 to 9.