Mending Broken Hearts: A Case Report on Right Ventricle Penetrating Injury
Based on echocardiography, penetrating injuries to thorax can be broadly classified into three groups:
Group I : chest wound, hemodynamically stable patient, possible penetration to heart
Group II : chest wound, hypotensive patient stabilized by aggressive fluid resuscitation, likely penetrating trauma to heart
Group III : chest wound, unresponsive, unconscious individual with dilated pupils, no pulse; ‘apparently dead’
Stab injuries, especially on the left side, are always associated with cardiac injury of some extent when patient is hemodynamically unstable. A journal reported a case of 28 years old male, with history of stab on left side of heart, who presented to ER with hemodynamic instability and altered mentation. Focused Assessment with Sonography in Trauma (FAST) revealed massive pericardial and left pleural collection. Intercostal drain was inserted and pericardiocentesis was planned.
Cardiopulmonary Resuscitation was successfully carried out when patient suffered from cardiac arrest. Pericardiocentesis further helped in reviving the heart function. Inotropic support and transfusion were started.
Despite the presence of pericardial drain, blood rapidly accumulated again in the pericardium which necessitated blood transfusion along with immediate sternotomy. Due to unavailability of crossed and uncrossed blood, autotransfusion was carried out.
Sternotomy revealed injury to right ventricle with severe haemorrhage, which was subsequently sutured by Teflon pledget 3-0 polypropylene suture. Neuroprotective prophylaxis was administered, and the temperature was maintained at 34°C. antibiotics were given to protect against infections.
Patient was extubated without any neurological sequelae.