TY  - JOUR
PY  - 2019//
TI  - Uneventful survival of a rural child after penetrating cardiac injury by a thorn: a case report
JO  - European heart journal. Case reports
A1  - De Decker, Rik
A1  - Li, Yifan Joshua
A1  - von Delft, Dirk
A1  - Meyer, Heidi
A1  - Mureko, Alfred
SP  - ytz106
EP  - ytz106
VL  - 3
IS  - 3
N2  - 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 (<i>Vachellia tortilis</i>) 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. <br><br>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 <i>in situ</i> 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.<br><br>© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.<p />  <p>Language: en</p>
LA  - en
SN  - 2514-2119
UR  - http://dx.doi.org/10.1093/ehjcr/ytz106
ID  - ref1
ER  -