Two Cases of Penetrating Cardiac Injuries Caused by Stab Wounds

Abstract

We report two cases of penetrating cardiac injuries due to stab wounds, which are rare in Japan. The patients were brought to the emergency room for self-inflicted trauma to the chest with a knife. Case 1 was a 66-year-old female with multiple stab wounds in the chest and abdomen, a JCS score of 300, and shock vitality. CT showed liver injury, left internal thoracic artery injury, and suspected left ventricular anterior wall injury ; thus, an emergency surgery was performed. In the anterior wall of the left ventricle, damage extending to the cardiac cavity was noted, which was repaired by suture closure with felt pledgets and tissue adhesives. The patient was extubated on postoperative day 1 ; no abnormal neurological findings were observed. CT scan on postoperative day 11 showed no coronary artery injury or pseudoaneurysm formation ; the patient was then transferred to a psychiatric hospital on postoperative day 12. Case 2 was an 88-year-old man with a 2-cm-long stab wound in the anterior chest. CT scan showed pericardial effusion with suspected acute hemorrhage, suggesting cardiac injury. However, since there was no contrast agent leakage from the pericardial cavity and the patient was in stable condition with clear consciousness, we concluded that he had only pericardial injury and chose conservative treatment. A CT scan performed about 12 h later showed that the pericardial fluid had already decreased. The patient was transferred to a hospital specializing in psychiatry on postoperative day 18.