A 45-year-old man presented with a self-inflicted stab wound to the chest, near the left lower parasternal area. He was evaluated at an outside facility, where the knife was removed carefully and the laceration wound was closed with a nylon suture. A computed tomography (CT) scan of the chest revealed hemopericardium and a mild to moderate left hemothorax. Hence, the patient was transferred to the authors’ hospital for emergency surgery. He was stable with good hemodynamics. A 2D echocardiogram showed good left ventricular function with moderate hemopericardium measuring up to 8 mm.
After consent was obtained, the patient was taken for surgery. A midline sternotomy was performed, and the pericardium was opened, which revealed blood clots. After thorough irrigation, a bleeder was identified on the right ventricle, as suspected, and was closed with multiple pericardial pledgets using 6-0 polypropylene sutures. The left pleura was opened, and blood and clots were suctioned. Inflammation was noted over the left internal mammary artery (LIMA) pedicle. Careful examination revealed an injury to one of the LIMA branches. A LIMA spreader was used to dissect the LIMA, and it was ligated at both the proximal and distal sites using silk sutures to control the bleeding. After thorough checking, the chest was closed routinely with two drains. The patient’s recovery was uneventful.
References
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- Cardiac Trauma: A Review of Penetrating and Blunt Cardiac Injuries. Carlin Lee, MD, Mallory Jebbia, MD, Jeffry Nahmias, MD, et al The American Surgeon Volume 91, Issue 3 https://doi.org/10.1177/00031348241307400
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