Citation

De Decker R, Li YJ, von Delft D, Meyer H, Mureko A. Eur. Heart J. Case Rep. 2019; 3(3): ytz106.

Affiliation

Division of Cardiothoracic Surgery, Department of Surgery, University of Cape Town, Faculty of Health Sciences, Anzio Road, Observatory, Cape Town, South Africa.

Copyright

(Copyright © 2019, Oxford University Press)

DOI

10.1093/ehjcr/ytz106

PMID

31660482

PMCID

PMC6764539

Abstract

BACKGROUND: Paediatric penetrating cardiac injury is extremely rare, precluding published management guidelines, therefore warranting a case-by-case approach with learning points gleaned from each case. CASE SUMMARY: A 7-year-old boy presented to a rural hospital with a stab wound to the chest by a Withaak (Vachellia tortilis) thorn. The patient was haemodynamically stable on presentation, but a 2 cm subcutaneous, pulsatile mass was present at the cardiac apex. Echocardiography revealed a foreign body penetrating from the apex into the heart, with evidence for a fistula between a cardiac chamber and the pulsatile mass. Angiography confirmed the existence of the fistula between the right ventricle (RV) and the pulsatile mass. A controlled extraction under general anaesthaesia via median sternotomy was performed in-theatre, with blood products and cardiac bypass on standby. The patient recovered without complications and was discharged after 4 days.

DISCUSSION: Our case illustrates the limitations of echocardiography in identifying the precise anatomical definition of penetrating cardiac injuries. Angiography is therefore indicated in such cases. The injury to the RV and the haemostatic effects of the in situ thorn were favourable prognostic factors. We believe that the mortality risk reduction of extraction under full control warrants the minor morbidity of a median sternotomy.

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.

Language: en

Keywords

Angiography; Case report; Echocardiography; Median sternotomy; Paediatrics; Penetrating cardiac injury