Most of the studies are retrospective and the patient selection is determined by the survivors arriving at the hospital and ignorance of the mortuary data. Topal et al. report a mortality rate of 15% in 61 penetrating cardiac cases with predominantly stab wounds but state that “patients pronounced dead on arrival were not assessed in this study” [33]. The only known prospective study PHA-848125 solubility dmso reports another reality with a mortality rate of 97% when multichamber penetrating injury is present [2]. Also Molina et al. reports high mortality (67%) in a cohort with mainly stab wounds throughout the last decennium [4]. Our patient maintained suboptimal circulation

for approximately two hours before undergoing surgery. The time span taken into consideration,

Bortezomib in vitro our patient was extremely lucky as the outcome is usually poor when the time from selleck trauma to surgery increases [5, 6]. An Israeli study of 14 patients reports 100% survival (9 SW, 2 GSW, 1 shrapnel injury and 1 multi trauma) with the mean time from injury to surgery of 37 min [7]. In addition to fast admission to surgery, this outstanding result may also be due to the fact that all patients had single chamber injuries and no coronary artery injury. According to Burack et al., patients with penetrating mediastinal trauma triage themselves between operative intervention or evaluation and observation as they present either stable or unstable on admission. In this retrospective study the authors present 207 patients of which 72 were unstable [10]. Of these 15% had cardiac injury with 18% survival when explored in the ED. The survival rate was 71% when patients with penetrating cardiac injury reached the operating room. All patients having

cardiac injury in this study were unstable (authors criteria: traumatic cardiac arrest or near arrest and an emergency department thoracotomy (EDT); cardiac tamponade; ATLS grad III shock despite fluid resuscitation; chest tube output >1500 ml at insertion; chest tube Carnitine palmitoyltransferase II output >500 ml in the initial hour; massive hemothorax after chest tube input). The study does not report the use of CPB. In our patient, there was a large stab wound of the left ventricle running parallel to the diagonal artery as well as a stab wound in the left atrium. Regarding the location of penetrating cardiac injury, the right ventricle is the most common due to its ventral anatomical position, followed by the left ventricle, right atrium and left atrium [2, 3, 11]. The patients with a single right ventricle injury are mostly salvagable whereas those with multichamber injuries have a very high mortality [2, 4, 21]. The concomitant injury of the lung in our patient is not a rarity [3]. Our patient did not suffer from cardiac tamponade as there was a large opening to the left pleural cavity through the wound in the pericardium. This probably saved his life, although profound hypovolemia can conceal signs of cardiac tamponade leading to delayed diagnosis [36].