Management of penetrating heart wounds (original) (raw)

Penetrating cardiac trauma: Management strategy based on 129 surgical emergencies over 2 years

The Annals of Thoracic Surgery, 1992

Between 1986 and 1988,129 patients with stab wounds to the heart were referred from the emergency room of our institution for a thoracic surgical procedure. Multiple entrance wounds of the heart were present in 12 patients, and through-and-through stab wounds were encountered in another 10. The overall hospital mortality rate was 8.5% (11/129), which includes a 54% mortality rate for the 13 patients undergoing emergency room thoracotomy. These patients were pulseless and unconscious either on arrival (n = 8) or soon thereafter (n = 5). Cardiopulmo-

Surgical Challenges for Urgent Approach in Penetrating Heart Injuries

The Heart Surgery Forum, 2007

The aim of this clinical study is to assess the characteristics of penetrating heart injury and its surgical challenges for urgent surgical approach. Materials and Methods: Seventeen patients suffering from penetrating heart wounds were evaluated retrospectively in the department of cardiovascular surgery between 1996 and 2004. All patients were male, with ages ranging from 19 to 36 years, with a mean age of 23.6 ± 5 years. Results: Median sternotomy, left anterior thoracotomy, and right anterior thoracotomy were performed to control the bleeding or to reach the heart for internal cardiac massage in 5, 11 and, 1 control, respectively. The right ventricle was the most commonly injured chamber (64.7%, n = 12), followed by left ventricle (17.7%, n = 4), and right atrium (17.6%, n = 3); a left atrial injury was not seen. Mortality rate was 29% (5 cases), and 12 controls were discharged without any complications. Conclusion: Although the most important factor affecting mortality in penetrating heart injuries is rapid transport, an urgent approach applied by a specialist team can decrease potential mortality and morbidity rates.

Current evaluation of cardiac stab wounds

The Annals of Thoracic Surgery, 1999

Background. Patients with penetrating cardiac injuries may be stable or only mildly shocked, especially if the laceration has sealed off and the patient has been aggressively resuscitated. Clinical signs, chest roentgenograms, pericardiocentesis, and subxiphoid window are not always helpful in establishing the diagnosis. We reflect on the current evaluation based on 128 patients.

Surgical Management of Penetrating Cardiac Trauma Patients

Kosuyolu Heart Journal, 2018

Introduction: Penetrating traumas, including gunshot and stab wounds, are the major causes of cardiac trauma. The aim of this study was to evaluate the diagnosis and surgical treatment in penetrating cardiac trauma patients. Patients and Methods: Forty-eight patients who underwent surgery for penetrating cardiac trauma between February 2009 and May 2017 were reviewed retrospectively. Transthoracic echocardiography, computed tomography angiography, and laboratory studies were performed if the patient was hemodynamically stable. Results: A total of 48 patients (45 males, 3 females; mean age 29.4 ± 11.1 years, range 16-51 years) were operated. Etiology was stab wound injury in 46 (95.8%) patients. Twenty-nine (60.4%) patients were in cardiogenic shock. In 44 cases, median sternotomy was performed. The most affected cardiac chamber was the right ventricle in 28 (58.3%) patients. The most common accompanying organ injury was the lungs with 15 patients. The mortality rate was 27.1% with 13 patients. Hemodynamic status of the patient, requirement of preoperative CPR, and preoperative hematocrit levels were found to have a significant effect on mortality. Conclusion: In penetrating cardiac trauma, early diagnosis and emergency surgery will improve overall survival rates. The hemodynamic status of patients on arrival have significant effect on prognosis.

Surgical management of stab injuries of the heart

Acta chirurgica iugoslavica, 2012

Itroduction. Cardiac injuries today are not rare and they present a significant group of pathological cardiac diseases, with a large number of the injured (60-90 %) dying before being transported to the hospital. Case report. A patient with a stab wound of the right chamber, upper abdomen and pelvis, in a state of hemorrhagic shock, was successfully managed after being reanimated. Conclusion. Good health service organization in the field and urgent transport of the injured should be obligatory in the management of heart trauma.

Penetrating Cardiac Injury

Gomal Journal of …, 2004

Management of penetrating cardiac injuries continues to be a challenge despite considerable improvement in healthcare facilities. The patient who reaches the hospital alive is usually in agony. The key to good outcome is prompt recognition of injuries, urgent surgical intervention and intensely monitored postoperative care. In patients with recent or impending cardiac arrest, resuscitative thoracotomy in emergency room is the only hope for survival. The poor outcome generally ascribed to the procedure is related to the cardiac injury itself. We report the management of a patient whose heart was lacerated by a motorized saw. This patient went into cardiac arrest upon arrival in emergency room. Resuscitative thoracotomy was performed in emergency room and his right ventricle was repaired successfully. The patient survived but suffered from ischaemic cerebral encephalopathy. The purpose of reporting this case is to highlight the role of early resuscitative thoracotomy in patients with impending or recent cardiac arrest due to penetrating cardiac trauma. The reported low survival should not deter the surgeon from attempting this procedure which can be life saving in a selected group of patients.

VP-011: Management of Penetrating Heart and Accompanying Lung Injuries

International Journal of Cardiology, 2011

Penetrating heart injury is potentially a life threatening condition due to cardiac tamponade or exsanguinating hemorrhage. The aim of this study was to evaluate victims who were referred to our hospital with penetrating heart and accompanying lung injuries and to review our overall outcome with this type of combined injuries. Methodology: Twenty patients with combined penetrating heart and lung injuries were operated at Yuzuncu Yil University Research Hospital, between May 1999 and January 2010. The diagnosis of combined heart and lung injuries was proved by surgical exploration in all cases. The surgical procedures mainly included the relief of cardiac tamponade, control of bleeding, repair of cardiac and pulmonary lacerations, and coronary artery bypass grafting if required. Results: In this series of 20 patients; there were 18 males and two females between the age of 14 to 60 years, with a mean age of 34.8±13.5 years. Seventeen victims sustained stab wounds, and the remaining three were injured by a gunshot wounds. In 20 patients there were 22 cardiac chamber injuries. The most commonly injured cardiac chamber was the right ventricle followed by the left ventricle. In addition to the injuries to heart muscle, injuries to the coronary arteries were found in two patients. The most commonly injured lung lobe was the left upper lobe. Conclusion: Our experience shows that early diagnosis and immediate surgical intervention are the main factors affecting patient survival after penetrating heart and lung injuries. Therefore, heart injury should always be kept in mind in victims with penetrating thoracic injuries.

Penetrating chest wounds: 24 years experience

World Journal of Surgery, 2001

Thoracic and thoracoabdominal penetrating wounds are frequently encountered in urban medical centers in the United States. This study was undertaken to determine the clinical characteristics and inhospital outcome of these injuries. This was a longitudinal, nonblinded study using the established standard of care of patients with penetrating chest trauma. It consists of an analysis of a consecutive series of 3049 patients treated at one trauma center between April 1972 and March 1996. There were 1347 stab wounds and 1702 gunshot wounds. Antibiotic prophylaxis was administered to patients who underwent laparotomy or thoracotomy or who had lung contusion with hemoptysis (41.6%, 1296/ 3049). Of 3049 patients, 196 had cardiac injuries. All of them underwent thoracotomy, and the mortality was 21.9%. In contrast, among 2853 patients without cardiac injuries, only 257 (9%) required thoracotomy; the mortality in this group was 1.5%. Patients with thoracoabdominal injuries (899/3049) had a mortality of 4.3% compared to 2.1% among those who had isolated chest injuries. The overall mortality was 2.8%. Of 1702 patients with gunshot wounds, 85 (5%) sustained transaxial injuries, with an overall mortality of 36.5%. The complication rate among the survivors was 6% with only 2.5% being infectious. We conclude that the mortality for noncardiac penetrating injuries of the chest is low. The presence of associated abdominal injuries increases the mortality twofold. More than one-third of the patients with transaxial wounds die. Gunshot wounds of the heart result in higher mortality than stab wounds to the heart. The infection rate is low.