Penetrating wounds of the heart and great vessels: A report of 30 patients

Abstract

In this series of 30 consecutively operated patients, two were probably dead from their cardiac wounds on arrival at hospital and two suffered extrapericardial large vessel injury. These four patients died. Among the remaining 26 patients who arrived alive in the emergency room with intrapericardial wounds, 23 (89%) survived during the four-and-a-half years covered by this report. These included five survivors in a subgroup of six patients with serious left ventricular wounds.The use of initial pericardiocentesis in 13, sternotomy in 10, and extracorporeal circulation in 7 of these 30 patients is emphasized.

Penetrating Wounds of the Heart and Pericardium

“…Traumatic sinus of Valsalva fistulae are extremely rare. In view of our experience and that of others (1,11,15) a badly damaged aortic valve is best dealt by prosthetic valve replacement.…”

“…According to American literature the transport mortality there is between 60 and 81 %. The mortality is directly related to the type of injury, for instance the mortality in stab wounds varies between 5 % and 18 % (1,15,17), whereas the mortality in bullet wounds varies between 24 % and 50 % (2,5,18). In all recent publications an aggressive surgical approach is recommended.…”

“…The work of Blalock and Ravitch (6), who advocated emergency pericardiocentesis, has considerably influenced the approach of generations of surgeons since 1943. In the more recent literature (1,2,3,5,7,8,11,15,16,17,18,19,20) there is a clear tendency away from the more conservative plan of management to early and more aggressive surgical intervention. Even today, "a penetrating wound of the pericardium and the heart is one of the most dramatic and potentially demanding emergencies that a "surgeon has to manage" (2).…”