縫い針により経心室中隔に心内シャントを形成した穿通性心外傷の１例

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  • Traumatic VSD caused by a sewing needle.

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This is a case report of a 45-year-old female patient who showed ventricular septal defect (VSD) resembling hemodynamics due to a needle-penetrating cardiac injury. She stabbed herself with suicidal intent in the left anterior side of her chest with two sewing needles. Chest X-Ray and CT showed one needle penetrating her left lung and the other her heart. When the needle was withdrawn from the heart through the anterior wall of the right ventricle following a median sternotomy, the patient's systolic blood pressure suddenly dropped from 100mmHg to 64mmHg. Dopamine infusion was required to maintain systolic blood pressure above 100mmHg for the following week. Although she had no previous history of heart disease, a pansystolic murmur with a thrill was detected by auscultation. Echocardiography and left ventricular angiography revealed VSD resembling hemodynamics with a Qp/Qs ratio of 1.3. Without any surgical intervention, her recovery course was uneventful. Although the murmur remained, the patient was asymptomatic, as far as we know, for not less than six months after the injury. We concluded that, in this case, the penetrating cardiac injury by a sewing needle suddenly created an intracardiac left to right shunt and caused obvious low cardiac output.

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