Wadaja Desalegn Fekadu, Tamirat Shibikom, Shewa Fikreyohanis, Muluneh Natinael, Ariaya Abraham, Demissie Wondu Reta
Adama Hospital Medical College, Department of Surgery, Adama, Ethiopia.
Addis Ababa University, College of Health Sciences, Department of Surgery, Addis Ababa, Ethiopia.
Int J Surg Case Rep. 2025 Apr;129:111214. doi: 10.1016/j.ijscr.2025.111214. Epub 2025 Mar 27.
Penetrating cardiac trauma is a highly lethal injury, with an overall mortality approaching 80 % for those who survive to reach the hospital. Factors influencing survival following penetrating cardiac injury (PCI) include age, mechanism of injury, anatomic site, and injury grade. Stab wounds account for 77.8 % of such injuries, while gunshot wounds account for 22.2 %. The right ventricle is the most frequently injured chamber (34.7 %), followed by the left ventricle (29.3 %).
This article presents a case of a 21-year-old male who presented 18 h after sustaining a stab injury to his anterior chest. The patient exhibited borderline blood pressure, severe bradycardia, and a focused assessment with sonography in trauma (FAST) revealed pericardial effusion with tamponade physiology. Immediate surgical intervention addressed the right ventricle injury. On the fourth postoperative day, echocardiography revealed ventricular septum and aortic injuries. The patient underwent prompt surgical repair of the septal injury, application of a prosthetic valve, and insertion of a permanent pacemaker, and was discharged in an improved condition.
Managing penetrating cardiac injury (PCI) in resource-limited areas presents significant challenges. In our case, the time between injury and intervention was notably prolonged at 18 h, contrasting with the reported 60-minute median in larger cohorts. Timely recognition and referral, especially for patients with precordial stabs, are critical in the management. Median sternotomy is the preferred incision for patients with penetrating precordial wounds; however, left thoracotomy, emergency room thoracotomy, and clamshell thoracotomy are alternative options. Following survival to the intensive care unit, echocardiography is imperative before discharge to rule out valvular, papillary, and interventricular injuries.
Timely intervention is imperative to improve outcomes and mitigate the impact of limited resources in low-income setting.
穿透性心脏创伤是一种致死率很高的损伤，对于那些存活至医院的患者，总体死亡率接近80%。影响穿透性心脏损伤（PCI）后存活的因素包括年龄、损伤机制、解剖部位和损伤分级。刺伤占此类损伤的77.8%，而枪伤占22.2%。右心室是最常受伤的腔室（34.7%），其次是左心室（29.3%）。
本文介绍了一名21岁男性的病例，该患者在胸前被刺伤18小时后就诊。患者血压临界、严重心动过缓，创伤重点超声评估（FAST）显示心包积液伴心包填塞征象。立即进行手术干预修复右心室损伤。术后第四天，超声心动图显示室间隔和主动脉损伤。患者迅速接受了室间隔损伤的手术修复、人工瓣膜植入及永久性起搏器植入，出院时病情有所改善。
在资源有限的地区处理穿透性心脏损伤（PCI）面临重大挑战。在我们的病例中，受伤至干预的时间明显延长至18小时，与大型队列报告的中位时间60分钟形成对比。及时识别和转诊，尤其是对于心前区刺伤患者，在治疗中至关重要。正中胸骨切开术是心前区穿透伤患者的首选切口；然而，左胸切开术、急诊室开胸术和蛤壳状开胸术也是可供选择的方法。在重症监护病房存活后，出院前必须进行超声心动图检查以排除瓣膜、乳头肌和心室间损伤。
在低收入环境中，及时干预对于改善预后和减轻资源有限的影响至关重要。
