Cardiac laceration

A patient was transferred to the Emergency Department of our hospital, having sustained two major stab injuries, about half an hour previously. One of the injuries was located in the epigastric area and the other one was evident just lateral to the xiphoid process and medial to the mid-clavicular line, at the level of the sixth intercostal space. Jets of blood were oozing from both lacerations and direct pressure was applied to control haemorrhage. The patient's breathing was compromised (SpO2 88%), he was in apparent hemodynamic shock (BP=85/55, pulses=140/min) and he was agitated (GCS=13/15). Two large-bore venous catheters were put in place and 2 liters of Ringer's lacted solution were administered immediately. The patient had also suffered two other stab injuries to his left forearm, causing major arterial lacerations; for the control of blood loss from these areas direct pressure was again immediately applied.

The victim was rushed to the operation room immediately upon presentation, where he was intubated and two units of uncrossed packed red blood cells administered. A thoracotomy tube that was put in place did not reveal hemothorax or pneumothorax.

Urgent laparotomy did not reveal abdominal hemorrhage or visceral trauma. The operating team proceeded to urgent left thoracotomy, in order to gain access to the mediastinum. This manoeuvre revealed a large (>6cm) laceration of the left cardiac wall, through which, the internal anatomical landmarks of the left cardiac cavities were clearly visible.

This cardiac laceration caused exsanguination and the patient died fifteen minutes after intubation in the OR.

Incidental findings of a previous thoracic operation were evident by means of fibrous tissue that had developed around the pericardium.

The survival of the patient for so long having sustained this serious injury was attributed to a tamponade effect of the major cardiac laceration by the aforementioned fibrous tissue.