No cupid, just an arrow: a penetrating injury into the interventricular septum

Abstract

Background Penetrating cardiac injuries are rare but often fatal, with 16–55% mortality. We report a patient who suffered a non-fatal occupational cardiac injury. Case presentation A 47-year-old man was operating an ironworker machine. A thin 3-cm metal fragment catapulted from the machine piercing the chest wall and the right ventricular outflow tract (RVOT), burrowing into the interventricular septum (IVS). The patient remained hemodynamically stable and walked to the nearest hospital. ECG-gated computed tomography revealed the exact location of the fragment within the IVS, allowing for detailed preoperative planning. The fragment was removed through a sternotomy and an incision through the RVOT. The postoperative course was uneventful. Conclusions This case underscores the value of detailed preoperative imaging and the wide spectrum of clinical scenarios of penetrating cardiac injuries.