Penetrating Cardiac Injury

Abstract

It is understood that penetrating cardiac trauma is a highly lethal injury and those surviving to hospital have an overall mortality approaching 80%. Reported mortality figures vary widely and are extremely dependent on mechanism of wounding, cardiac chambers involved and possibly the presence of cardiac tamponade. Despite significant advances in prehospital care, operative techniques, and intensive care management, the mortality has not changed over several decades. This article will review the anatomic regions of concern for a cardiac injury, clinical presentation, and physical findings. The need for an expeditious evaluation and modalities available including, plain radiographs, sub-xiphoid window, and echocardiography will be considered. Options for surgical exposure, technical details of repairing cardiac injuries, and special circumstances such as injury adjacent to a coronary artery and intra-cardiac shunts are discussed in detail. Outcome data and future directions in managing this challenging injury are also examined.

Penetrating cardiac injuries: Review of 19 cases

“…Bu esnada mayi replasmanı ile hemodinamik stabilite hızla sağlanarak defektin nasıl kapatılacağı planlanır. [15] Basit miyokard laserasyonları pledget destekli polipropilen dikişler ile miyokarddan tam kat geçilerek onarılabilir. Koroner damarlara yakın bölgedeki laserasyonlarda, matress sütürler damarın altındaki miyokard dokusundan, kan akımını engellemeyecek şekilde geçilmelidir.…”

Challenges in the Management of Penetrating Cardiac Injuries in Taiz, Yemen

“…Available data in the literature regarding the survival benefit from tamponade after cardiac surgeries remains contradictory. While increased survival from tamponade has been reported in a number of studies, some reports have shown the absence of such a benefit (1,16,19). Moreover, the cardiovascular condition and consciousness status of victims upon hospital arrival significantly contribute to the predictable outcome of penetrating cardiac injuries (13).…”

“…Penetrating cardiac injuries are among the most lethal of all traumatic injuries, with many studies reporting mortality rates of 70-90% (1)(2)(3). The number of such injuries is a very small proportion of annual trauma admissions (0.1%) in most reports (4,5).…”

Cardiac Trauma

“…Ancak bunlar miyokardda daha çok hasara neden olabilir. Basit dijital kompresyon ile geçici olarak kanama durdurmak basit ve etkili bir yöntemdir (35). Atriyum yaralanmalarında vasküler klamp uygulanarak, 3/0 ya da 4/0 polipropilen sütürlerle onarım yapılabilir.…”

“…Kalp kaldırıldığında hipotansiyon, bradikardi ve arrest ortaya çı-kabilir. Bu tür onarımlarda, kalbin tolere ettiği ölçüde kısa aralıklarla kalp kaldırılıp tekrar hemodinami toparlayana dek bekleyerek, her seferinde hasarın yerinin tesbiti, sütürlerin geçilmesi ve bağlanması yavaş yavaş yapılarak onarım gerçekleştirilebilir (35). Bu durumlarda, kalp hızını yavaşlatıp kısa süreli asistoli sağlaması için adenosine infüzyonu uygulanabilmektedir (36).…”