Penetrating Cardiac Trauma

Abstract

Penetrating cardiac injuries remain a difficult challenge to most surgeons. They are one of the leading causes of death. We report a case of a 25-year-old male who sustained a penetrating injury to the heart. He was brought in unconscious state with severe shock. Prompt aggressive resuscitation was initiated and an emergency thoracotomy performed. The patient had uneventful recovery and he was discharged from the hospital seven days later without untoward sequelae. The relevant literature has been reviewed. This is the first case reported in the Salmaniya Medical Center since the establishment of medical records in 1987. Penetrating cardiac injuries can present a diagnostic challenge to the accident and emergency physicians. Patients with these injuries may present in a stable condition or in shock. The clinical signs, chest roentgenogram, pericardiocentesis results and electrocardiographic changes are inconclusive in establishing the diagnosis and may presents as a diagnostic dilemma 1,2 . However, cardiac catheterization can accurately diagnose penetrating trauma to the heart. This procedure will provide information about the specific area of the heart involved, whether the cardiac valves or coronary vessels have been damaged and if any intracardiac shunts have been created. But this approach is considered to be time consuming and is not appropriate for the initial evaluation of the trauma patient 3,4 . One effective technique is the use of subxiphoid pericardial windows, which represents a rapid method for the accurate diagnosis of such injuries and should be considered as the gold standard for the evaluation of penetrating cardiac trauma 5 . An alternative approach is to utilize serial echocardiography. In a recent series of patients with cardiac penetrating chest wounds and stable vital signs, two dimensional echocardiography was found to be 90% sensitive and 97% specific for the diagnosis of cardiac penetration 5,6 .