Emergent Surgical Intervention for a Right Ventricular Stab Wound in a Young Man: A Case Report

Abstract

Introduction: Penetrating cardiac injuries (PCIs) require prompt diagnosis because of the risk of hemodynamic instability. Diagnostic clues include abnormalities on chest radiography and pericardial effusion on ultrasound. Although sometimes necessary, emergency department thoracotomy is associated with a higher mortality risk. Case Presentation: A 25-year-old male presented with a chest stab wound and dyspnea but stable vital signs. The initial assessment revealed a small pericardial effusion and complete opacification of the left hemithorax on chest radiography, consistent with a massive hemothorax. Despite initial stability, the patient deteriorated, with decreasing blood pressure and an increasing heart rate. An emergency left anterolateral thoracotomy revealed a 1-cm right ventricular laceration, which was successfully repaired. Postoperative echocardiography showed preserved left ventricular function. General surgeons repaired the right ventricular laceration without cardiopulmonary bypass. The patient was transferred for further cardiac care, recovered, and was discharged on the sixth postoperative day. Conclusions: PCIs vary in presentation and severity and are associated with high prehospital mortality rates. Most cases can be managed by general surgeons, with specialized care required only for severe cases.