Critical Surgical Management Pearls in Penetrating Cardiac Nail Gun Injury

BACKGROUND: Penetrating cardiac injuries are typically fatal. Nail gun injuries to the heart are rare, and surgical repair is warranted. CASE SUMMARY: This case details a rare, self-inflicted injury where multiple nails were discharged into a patient's heart and head. Remaining hemodynamically stable at presentation, he underwent a computed tomography scan to delineate the trajectory and location of the intracardiac nails. Successful removal and repair of the myocardium was carried out under cardiopulmonary bypass. Subsequent removal of the intracranial nails was performed, and the patient made a full recovery. DISCUSSION: Penetrating injury to the heart via nail gun discharge is rare, and this case addresses diagnosis and surgical management of such injury. TAKE-HOME MESSAGES: Nail gun injuries to the heart require prompt surgical management, and the resulting injury can vary from simple to complex given the high velocity of the impact and the small caliber of the nails. Additional preoperative imaging should be considered whenever clinically feasible to facilitate surgical planning.