A severe penetrating cardiac injury in the absence of cardiac tamponade

Abstract

Penetrating cardiac injury is rare and frequently not survivable. Significant haemorrhage resulting in cardiac tamponade commonly ensues. Such cardiac tamponade is a clear clinical, radiological and sonographic indicator of significant underlying injury. In the absence of cardiac tamponade, diagnosis can be more challenging. In this case of a 26-year old sailor stabbed at sea, a significant pericardial effusion and cardiac tamponade did not occur despite an injury transversing the pericardium. Instead, the pericardial haemorrhage drained into the left pleural cavity resulting in a haemothorax. This case is notable due to a favourable outcome despite a delay in diagnosis due to a lack of pericardial effusion, a concomitant cerebrovascular event and a long delay from injury to appropriate medical treatment in the presence of a penetrating cardiac wound deep enough to cause a muscular ventricular septal defect and lacerate a primary chordae of the anterior mitral leaflet.

Penetrating cardiac trauma mimicking congenital sinus Valsalva aneurysm rupture: A case report

“…Multi-chamber injuries constitute a lower percentage of cases with a predominant single right ventricle injury. [1,2] The present case is unique, as it is a late admission and had no signs of hemodynamic compromise,…”

“…The injury is usually nonaccidental, predominantly sustained by males, and the mortality rate is about 60%, which further increases where pericardial tamponade is absent. [1,2] In a recent large series, 86% of injuries constituted single chamber injury, predominantly right ventricle (46%) and left ventricle (24%), whereas multi-chamber injuries were seen in 18% of cases. Patients typically manifest with signs of cardiac tamponade, cardiac arrest, or signs of extremis from exsanguination.…”

Late discover of a traumatic cardiac injury: Case report

“…Such cardiac tamponade is a clear clinical, radiological and sonographic indicator of signi icant underlying injury. In the absence of cardiac tamponade, diagnosis can be more challenging [1]. We present the case of a neglected cardiac injury, resulting in a mitral valve regurgitation and ventricular septal defect, discovered forty ive days after the initial trauma in a 25-year-old man presenting with signs of heart failure.…”

Penetration cardiac wound associated with anterior mitral leaflet perforation: a case report and review of the literature

“…Наиболее часто повреждается межжелудочковая перегородка (МЖП), реже -стенки аорты на границе с правыми отделами сердца, наиболее редко -атриовентрикулярные и полулунные клапаны [10]. Описание в литературе сочетания посттравматического дефекта МЖП и ранения структур митрального клапана встречается довольно редко [10][11][12][13][14]. J. Skoularigis и соавт.…”

“…«Самопроизвольное излечение» после проникающих ранений сердца и внутрисердечных структур встречается довольно редко [13,17], и в подавляющем большинстве случаев спустя некоторое время пациенты, обращаясь повторно с симптомами сердечной недостаточности, подвергаются оперативному лечению уже в специализированных учреждениях [17,18].…”