O uso da tomografia computadorizada na triagem da lesão cardíaca penetrante.

Góes, Adenauer Marinho de Oliveira; Oliveira, Édpo Vinicius Lenzi de; Albuquerque, Flávia Beatriz Araújo de; Martins, Eduardo Gorayeb; Andrade, Mariseth Carvalho de; Abib, Simone de Campos Vieira

doi:10.1590/0100-6991e-20192154

Cited by 4 publications

(13 citation statements)

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“…The main mechanism of PCI was SW with an incidence of 67%, which is in accordance with literature, that reports an incidence from 43 to 74%. (Jones et al, 2014;Kaljusto et al, 2015;Stranch, Zarzaur and Savage, 2017;Góes Junior et al, 2019) However, different authors have reported an increase of GSW over SW, which could be best explained for the easy access to guns in different countries. (Campbell et al, 1997;Asensio et al, 2009;Seamon et al, 2015;Morse et al, 2016) Ventricles were compromised on 67% of the cases, and that may be best explained for its size.…”

Section: Discussionmentioning

confidence: 99%

“…They remain the most affected chambers of the heart, around 60-70% (Thorson et al, 2012;Besir, Gokalp and Eygi, 2015;Kaljusto et al, 2015;Seamon et al, 2015). However, the right ventricle is the most affected chamber (Topal, Celik and Eren, 2010;Thorson et al, 2012;Morse et al, 2016;Góes Junior et al, 2019); this can be explained due to the anatomical disposition, as the right ventricle lies just posterior to the sternum, and it is more approachable to SW. (Kang et al, 2009)…”

Section: Discussionmentioning

confidence: 99%

“…(Lee et al, 2009;Co et al, 2011) Computed Tomography is a reliable exam to perform on stable patients. When talking about penetrating cardiac injuries, Góes Junior et al, (2019) found a sensitivity of 56.5%, specificity of 85.7%, positive predictive value of 65% and negative predictive value of 80.7%. (Góes Junior et al, 2019) Possible findings that must be ruled out during CT to identify heart injury are pneumopericardium and hemopericardium.…”

Section: Imagingmentioning

confidence: 99%

“…When talking about penetrating cardiac injuries, Góes Junior et al, (2019) found a sensitivity of 56.5%, specificity of 85.7%, positive predictive value of 65% and negative predictive value of 80.7%. (Góes Junior et al, 2019) Possible findings that must be ruled out during CT to identify heart injury are pneumopericardium and hemopericardium. However, if a hemopericardium is first identified in an ultrasound, time should not be wasted to perform a CT, for it could worsen the clinical status of the patient.…”

Section: Imagingmentioning

confidence: 99%

“…(Plurad et al, 2013) Furthermore, the CT gives the advantage to evaluate the lungs, searching for sings of lesions, such as looking for hemothorax in the pleural space, or hemomediastinum, pneumomediastinum, or mediastinal hemorrhage. (Plurad et al, 2013;Góes Junior et al, 2019) It is also effective to detect pericardial or myocardial lacerations, cardiac luxation, path of a projectile, or location of a foreign body. (Hanpeter et al, 2000;Shanmuganathan and Matsumoto, 2006;Raptis, Bhalla and Raptis, 2019) Valvular compromise should be suspected whenever a pulmonary edema develops after a penetrating cardiac injury.…”

Section: Imagingmentioning

confidence: 99%

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Solving the impossible. Penetrating cardiac injuries, a case series of diagnostic workup and management

Vergara-Miranda

Álvarez-Lozada

Leyva-Alamillo

et al. 2021

IJMSS

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For a long time, any heart-based injury was an off-limits area for surgeons; a patient with a traumatic cardiac injury was doomed to die. Little more than one hundred years have passed since the first surgical correction of a penetrating cardiac injury and there is still a high rate of mortality, despite the medical advances. We present the case of 6 patients with penetrating cardiac injuries that were repaired at a third level hospital of Mexico, alongside relevant findings on the literature about the topic. From 2019 to 2020, an incidence of 6 patients with penetrating cardiac injuries was present; all men aged 30 years or older. The etiology of 4 (67%) patients was stab wounds and 2 (33%) gunshot wounds. Left anterolateral thoracotomy was used on 5 (83%) patients and midline sternotomy on 1 (17%) patient. 2 (33%) injuries on the left ventricle presented along with coronary arteries injuries. Left ventricle and right atrium injuries presented each 50% of mortality. The mortality was of 33%, 1 patient died due to intraoperative complications and another one due to massive cerebral infarction and polyuric syndrome because of diabetes insipidus. There is a long path ahead of the surgical field on this topic and further to be analyzed. An excellent tool for cardiac tamponade diagnosis due to penetrating cardiac injuries is cardiac ultrasound, therefore it should be used on every hemodynamic unstable patient in the context of PCI. Definitively, time is of the essence, and the survival of patients depends on immediate transport to a hospital and an opportune surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

See 3 more Smart Citations

Solving the impossible. Penetrating cardiac injuries, a case series of diagnostic workup and management

Vergara-Miranda

Álvarez-Lozada

Leyva-Alamillo

et al. 2021

IJMSS

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Predicting mortality in penetrating cardiac trauma in developing countries through a new classification: Validation of the Bogotá classification

Pulido

Reyes

Enríquez

et al. 2022

Health Science Reports

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Introduction Penetrating chest trauma (PCT) represents 10% of worldwide mortality, with developing countries counting as some of the most affected by high mortality rates due to cardiac trauma. Colombia is considered one of the most violent countries due to the high mortality rate associated with war and crime, hence the validation of an own classification for penetrating cardiac injuries (PCI) is mandatory. Methods Retrospective cross‐sectional study which included adult patients with PCIs at a level 4 trauma center in Colombia, between January 2018 and April 2020. We used our own system (Bogotá Classification) and compared it with traditional systems (e.g., Ivatury's, OIS‐AAST), by analyzing the mechanism of injury (MOI), the hemodynamic status of the patient at admission, the inpatient management, the individual outcomes, and some demographic variables. Bivariate statistical analysis, spearman correlation, and logistic regression were performed. Results Four hundred and ninety‐nine patients were included. Bivariate analysis demonstrated a significant relationship between mortality and hemodynamic state, MOI, its location and degree of lesion, cardiac/vessel injury, cardiac tamponade, time between injury and medical care, fluid reanimation, as well as the Ivatury's classification and the new classification (p < 0.005). The adequate correlation between Ivatury's and Bogotá classification supports the latter's clinical utility for patients presenting with PCI. Likewise, logistic regression showed a statistically significant association among mortality rates (p < 0.005). Conclusions The Bogotá classification showed similar performance to the Ivatury's classification, correlating most strongly with mortality. This scale could be replicated in countries with similar social and economic contexts.

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The importance of simulation education for the management of traumatic cardiac injuries: a case series

et al. 2019

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BackgroundThe management of cardiac trauma requires rapid intervention in the emergency room, facilitated by a surgeon with prior experience to have good outcomes. Many surgeons have little experience in the requisite procedures. We report here 4 patients who suffered cardiac trauma, and all 4 patients survived with good neurologic outcomes.Case presentationsPatient 1 suffered blunt cardiac trauma from a motor vehicle accident and presented in shock. Cardiac tamponade was diagnosed and a cardiac rupture repaired with staples through a median sternotomy after rapid transport to the operating room. Patient 2 suffered blunt cardiac trauma and presented in shock with cardiac tamponade. Operating room median sternotomy allowed extraction of pericardial clot with recovery of physiologic stability. Patient 3 presented with self-inflicted stab wounds to the chest and was unstable. She was brought to the operating room and thoracotomy allowed identification of a left ventricle wound which was repaired with a suture. Patient 4 presented in cardiac arrest with multiple self-inflicted stab wounds to the chest. Emergency room thoracotomy allowed repair of a right ventricle laceration with recovery of vital signs.ConclusionsThe management of all 4 patients was according to the principles taught in the ATOM course. Three of the 4 surgeons had no prior experience with management of cardiac trauma and credited the good outcomes to taking the ATOM course. These are uncommon injuries and formal training in their management is beneficial to patients.

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O uso da tomografia computadorizada na triagem da lesão cardíaca penetrante.

Cited by 4 publications

References 15 publications

Solving the impossible. Penetrating cardiac injuries, a case series of diagnostic workup and management

Solving the impossible. Penetrating cardiac injuries, a case series of diagnostic workup and management

Predicting mortality in penetrating cardiac trauma in developing countries through a new classification: Validation of the Bogotá classification

The importance of simulation education for the management of traumatic cardiac injuries: a case series

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