Case presentation A 28-year-old male was admitted to the emergency department (ED) with a 5 cm stab wound (SW) under his left nipple. Pre-hospital treatment included insertion of a left chest drain due to dyspnoea, but this was clamped during transport because of massive hemorrhage. On admission, he was self-ventilating, with palpable carotid pulses, but without a measurable Belnacasan in vivo blood pressure. He was agitated and pale with a Glasgow coma score of 12 since he could open his eyes, localize pain and speak. The blood

pressure ranged from 80/60 to 100/60 mmHg after starting intravenous fluid therapy and he had a tachycardia of 100–120 beats per minute. When the clamp was removed from the chest drain, 650 ml of blood was rapidly drained. The chest x-ray showed persisting hemothorax and atelectasis and an additional drain was inserted. The arterial saturation varied from 86% to

98% and blood gas analysis showed a haemoglobin mTOR inhibitor of 12.6 g/l, pH 7.17, base excess −9 and lactate 5.5 mmol/l. Focused selleck chemicals Assessment with Sonography in Trauma (FAST) revealed no blood in the pericardium and upper abdomen. The neck veins were not distended and so the patient received transfusion of 1500 ml of crystalloid fluid and 250 ml of red cells. The blood pressure decreased as soon as the intravenous therapy was reduced, the tachycardia did not resolve Cyclic nucleotide phosphodiesterase and the patient was therefore transferred to the operating room. After intubation, the ECG showed ST elevation and a median sternotomy incision was rapidly performed. The pericardium was opened and although there was a clot ventral to the heart,

there were no signs of cardiac tamponade. There was a 6 cm cut in the lateral pericardium corresponding to the stab wound in the chest and a 7 cm, almost transmural wound in the left ventricle, parallel to a major diagonal branch (Figure1). The wound was not bleeding. A 5 cm stab wound in the left lung (Figure2) was sutured and cardiopulmonary bypass (CPB) was established. The cardiac injury ended close to the origin of the left main stem and crossed the left atrium. The ventricular wound was repaired with single mattress sutures reinforced by strips of bovine pericardium (Figures 3, 4) without arresting the heart and without cross-clamping the aorta.