Penetrating cardiac injury repaired under "intentional cardiac arrest" with adenosine triphosphate

BACKGROUNDRepairing a cardiac injury with beating heart is sometimes difficult and is associated with increased risks of complications. Here we report a case of cardiac injury repaired with administration of adenosine triphosphate (ATP). CASE PRESENTATIONA 46-year-old man was stabbed in his chest with a knife and transferred to our hospital. He was hemodynamically unstable, and echocardiography showed pericardial effusion. Emergency thoracotomy revealed a full-thickness injury in the right ventricle next to the coronary artery. He went into cardiac arrest and was resuscitated with adrenaline administration. We tried to suture immediately, but it was difficult because of tachycardia. After administering 20 mg of ATP (80 mg in total over 15 min), bradycardia was induced that led to "intentional cardiac arrest" after which suturing was performed. He was discharged on the 13th day without complications. CONCLUSIONCases of penetrating cardiac injury repaired using ATP are rare. Administration of ATP may be a useful option while repairing cardiac injuries.