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Case Reports in Surgery
Volume 2014 (2014), Article ID 985097, 3 pages
http://dx.doi.org/10.1155/2014/985097
Case Report

Transmediastinal and Transcardiac Gunshot Wound with Hemodynamic Stability

Servicio de Cirugía General II, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain

Received 27 April 2014; Accepted 5 August 2014; Published 17 August 2014

Academic Editor: Angelo Carretta

Copyright © 2014 Leire Zarain Obrador et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cardiac injuries caused by knives and firearms are slightly increasing in our environment. We report the case of a 43-year-old male patient with a transmediastinal gunshot wound (TGSW) and a through-and-through cardiac wound who was hemodynamically stable upon his admission. He had an entrance wound below the left clavicle, with no exit wound, and decreased breath sounds in the right hemithorax. Chest X-ray showed the bullet in the right hemithorax and large right hemothorax. The ultrasound revealed pericardial effusion, and a chest tube produced 1500 cc. of blood, but he remained hemodynamically stable. Considering these findings, a median sternotomy was carried out, the through-and-through cardiac wounds were suture-repaired, lung laceration was sutured, and a pacemaker was placed in the right ventricle. The patient had uneventful recovery and was discharged home on the twelfth postoperative day. The management and prognosis of these patients are determined by the hemodynamic situation upon arrival to the Emergency Department (ED), as well as a prompt surgical repair if needed. Patients with a TGSW have been divided into three groups according to the SBP: group I, with SBP  mmHg; group II, with SBP 60–100 mmHg; and group III, with SBP  mmHg. The diagnostic workup and management should be tailored accordingly, and several series have confirmed high chances of success with conservative management when these patients are hemodynamically stable.