# No cupid, just an arrow: a penetrating injury into the interventricular septum

## TL;DR

A rare non-fatal case of a metal fragment piercing the heart is reported, highlighting the importance of detailed imaging and careful surgical planning.

## Contribution

A unique clinical case of a penetrating cardiac injury with successful management is presented.

## Key findings

- A metal fragment pierced the chest wall and interventricular septum without causing immediate fatality.
- ECG-gated CT provided precise preoperative imaging, enabling successful surgical removal of the fragment.
- The case demonstrates the variability and potential manageability of penetrating cardiac injuries.

## Abstract

Penetrating cardiac injuries are rare but often fatal, with 16–55% mortality. We report a patient who suffered a non-fatal occupational cardiac injury.

A 47-year-old man was operating an ironworker machine. A thin 3-cm metal fragment catapulted from the machine piercing the chest wall and the right ventricular outflow tract (RVOT), burrowing into the interventricular septum (IVS). The patient remained hemodynamically stable and walked to the nearest hospital. ECG-gated computed tomography revealed the exact location of the fragment within the IVS, allowing for detailed preoperative planning. The fragment was removed through a sternotomy and an incision through the RVOT. The postoperative course was uneventful.

This case underscores the value of detailed preoperative imaging and the wide spectrum of clinical scenarios of penetrating cardiac injuries.