Penetrating cardiac injury with non-coronary cusp aortic valve rupture and ventricular septal injury: A case report.

Abstract

Background and importance: Penetrating cardiac trauma is a highly lethal injury, with an overall mortality approaching 80 % for those who survive to reach the hospital. Factors influencing survival following penetrating cardiac injury (PCI) include age, mechanism of injury, anatomic site, and injury grade. Stab wounds account for 77.8 % of such injuries, while gunshot wounds account for 22.2 %. The right ventricle is the most frequently injured chamber (34.7 %), followed by the left ventricle (29.3 %).

Case presentation: This article presents a case of a 21-year-old male who presented 18 h after sustaining a stab injury to his anterior chest. The patient exhibited borderline blood pressure, severe bradycardia, and a focused assessment with sonography in trauma (FAST) revealed pericardial effusion with tamponade physiology. Immediate surgical intervention addressed the right ventricle injury. On the fourth postoperative day, echocardiography revealed ventricular septum and aortic injuries. The patient underwent prompt surgical repair of the septal injury, application of a prosthetic valve, and insertion of a permanent pacemaker, and was discharged in an improved condition.

Clinical discussion: Managing penetrating cardiac injury (PCI) in resource-limited areas presents significant challenges. In our case, the time between injury and intervention was notably prolonged at 18 h, contrasting with the reported 60-minute median in larger cohorts. Timely recognition and referral, especially for patients with precordial stabs, are critical in the management. Median sternotomy is the preferred incision for patients with penetrating precordial wounds; however, left thoracotomy, emergency room thoracotomy, and clamshell thoracotomy are alternative options. Following survival to the intensive care unit, echocardiography is imperative before discharge to rule out valvular, papillary, and interventricular injuries.

Conclusion: Timely intervention is imperative to improve outcomes and mitigate the impact of limited resources in low-income setting.