An unusual fatal penetrating coronary artery injury with effective perioperative management.

We report here an uncommon anterior chest trauma with an unusual fatal penetrating coronary artery injury by pneumatic nail gun with effective perioperative management. While doing upholstery, a 32-year-old male patient accidentally stabbed by a pneumatic nail gun with injury to the anterior chest was brought to the emergency room of our hospital. Persistent chest pain with unstable vital signs and no external injury except for a faint ecchymosis on anterior chest were noted at arrival. Sixty-four-slice computed tomography (CT) scan revealed a foreign body completely embedded in the chest wall penetrating the left ventricle, with the coronary artery also suspected of being involved because of ST-T changes of V2 to V6 on electrocardiography. Three-dimensional reconstructive CT scans showed a penetrating injury to the left anterior descending coronary artery without complete transection. Thereafter, we performed the operation of nail removal with direct repair of coronary artery that was scheduled based on the image findings preoperatively, and the operation was smoothly performed without coronary artery cardiopulmonary bypass and grafting bypass effectively and simply. He was discharged uneventfully 14 days later. Another CT scan was performed which showed patency of repaired coronary artery 3 months later.