Conservative management of myocardial lesions secondary to stable penetrating precordial trauma with a positive pericardial window by thoracoscopy, clinical case report

Penetrating precordial injuries are becoming more frequent. Of every 100 patients with these injuries and hemodynamically stable, 15%-20% have an occult heart injury. If the pleura has been violated, the pericardial window can be performed subxiphoid, laparoscopic with a trans diaphragmatic window, or thoracoscopic. The objective of the study is: to describe the case of a patient with conservative management of myocardial injury secondary to penetrating precordial trauma by a sharp weapon, with a positive pericardial window by thoracoscopy.

Clinical case: A 36-year-old male patient, with no pathological history, was admitted to the Teófilo Dávila Machala-Ecuador General Hospital, with a diagnosis of penetrating chest trauma plus penetrating precordial wound, hemodynamically stable.

Evolution: A conservative management of the myocardial lesion was performed, after a positive pericardial window by thoracoscopy plus thoracostomy, after four days of hospitalization he was discharged with favorable evolution. There were no complications or readmission after 3 months of monitoring and control by external consultation.

Conclusion: In hemodynamically stable patients with penetrating precordial wounds and a positive pericardial window who present cardiac injury without active bleeding, are amenable to conservative management, this is a minimally invasive alternative that is less morbid and as safe as open techniques.