DOI: https://doi.org/10.36347/sjmcr.2026.v14i02.020

Pages: 257-262

Penetrating cardiac injuries remain among the most lethal forms of trauma, with mortality rates reaching 70–80% before patients even reach the hospital. Survivors often depend on rapid diagnosis, coordinated resuscitation, and immediate surgical intervention. Right-sided cardiac chambers are more frequently injured due to their anterior position, yet successful repair requires swift operative judgment and a multidisciplinary trauma response. This case series highlights two survivors of penetrating cardiac trauma presenting to two Malaysian tertiary cardiothoracic centers, demonstrating the critical importance of rapid recognition and surgical expertise. Case Presentation: Case 1 involved a young male who sustained a stab wound to the chest, presenting in extremis with hypotension and muffled heart sounds. Extended Focused Assessment with Sonography for Trauma [E-FAST] revealed pericardial effusion consistent with tamponade physiology. CT showed a focal contrast leak along the right cardiac border, raising suspicion of a right atrial injury. Emergency sternotomy revealed a 1-cm full-thickness laceration at the right atrial free wall, actively bleeding. The defect was primarily repaired using pledgeted polypropylene sutures, achieving complete hemostasis. The patient made an uneventful recovery. Case 2 presented as a penetrating precordial trauma with hemodynamic instability and worsening echocardiographic features of tamponade. CT demonstrated a defect along the right ventricle free wall with adjacent hematoma, consistent with penetrating cardiac injury. Emergency median sternotomy revealed a right ventricular laceration, which was repaired using interrupted polypropylene sutures buttressed with pledgets. The patient was successfully weaned from inotropes and extubated on postoperative day two, with no postoperative arrhythmias or cardiac dysfunction. Discussion: Both cases underscore the principle that time is myocardium in penetrating cardiac trauma. Early recognit