Penetrating Wounds of the Heart

Trauma: The most progressive subspecialty of all

“…Naclerio, MD (1914-1985 in New York City in 1964. 29 After 40 years of consistent approach to penetrating cardiac wounds, surgeons at Groote Schuur Hospital/University of Cape Town suggested an alternate approach similar to that proposed by Blalock and Ravitch in 1943 and then studied it in a randomized trial. 30 In this approach in stable patients with a "suspected hemopericardium," a subxiphoid pericardial window is performed first followed by irrigation of the pericardial sac.…”

“…4 B ) from Johns Hopkins in 1943 28 . They recommended the following for patients with a suspected hemopericardium after thoracic trauma: (a) aspirate the blood from the pericardium by the costoxiphoid route, if possible; (b) repeat if there is a recurrence; (c) if it again recurs, perform a cardiorrhaphy through an extrapleural exposure.” Significant confusion and controversy followed for the next 20 years, until the definitive article on the importance of thoracotomy and cardiorrhaphy by Emil A. Naclerio, MD (1914–1985) in New York City in 1964 29 …”

Penetrating injuries of the heart

“…Although there may be considerable improvement after aspiration, the manmuvre may provoke further bleeding and lead to a recurrence of tamponade. The common occurrence of clotted blood in the pericardial sac may account for the high incidence of negative pericardiocentesis in some series (Ransdell and Glass, 1960;Naclerio, 1964). Although pericardiocentesis was attempted in only 4 patients in this series, the frequent occurrence of anterior and inferior located clots makes it likely that the procedure would have been a failure as a therapeutic measure.…”

Verletzungen des Herzens mit spät einsetzender Symptomatik

“…Sie wird von MAYNARD u. Mitarb. [20] mit 20% und von DERRA [7] in einer Literaturübersicht mit 16 bis 35% angegeben, während NACLERIO [23] Eine zweite Gruppe von Patienten überlebt die Herzverletzung so lange, daß der rasche Transport in ein Krankenhaus erfolgen und dort mit einer Therapie begonnen werden kann [34]. Es handelt sich dabei um weniger ausgeprägte Verletzungen, bei denen insbesondere ein nur unbedeutend verletztes oder unversehrtes Perikard einen raschen Blutverlust in die Pleu rahöhle nicht zuläßt.…”