Emergency surgical techniques for left ventricular gunshot injury in resource-limited settings: A case report

Penetrating cardiac injuries are associated with a high mortality rate and require immediate surgical intervention, especially in resource-limited settings where standard repair materials may be unavailable. We report the case of a 28-year-old man who sustained a self-inflicted gunshot injury to the left chest, resulting in a penetrating left ventricular wound. On presentation, he was hemodynamically unstable and imaging suggested left hemopneumothorax with possible hemopericardium. An emergency thoracotomy revealed a large 3 × 4 cm defect in the left ventricle with associated lung injury and massive hemothorax. Temporary hemorrhage control was achieved using a Foley catheter inserted through the ventricular defect. Because primary repair was not feasible due to friable myocardial tissue, an autologous latissimus dorsi skeletal muscle patch was harvested and secured over the defect. The postoperative course was complicated by superficial surgical site infection, which was managed successfully. Early postoperative echocardiography showed preserved left ventricular function (LVEF 55%). At one-year follow-up, echocardiography demonstrated regional wall motion abnormality with a reduced LVEF of 45%, suggesting late scar-related dysfunction. However, a subsequent echocardiographic assessment approximately 22 months after surgery showed recovery of global left ventricular systolic function (LVEF 60%) with no segmental wall motion abnormality. This case highlights the value of simple damage-control techniques and autologous tissue repair for life-threatening cardiac trauma when conventional materials are unavailable, while emphasising the need for long-term cardiac follow-up.