Missile Cardiac Injuries: Review of 16 years experience

BACKGROUND
Penetrating cardiac trauma represents an increasingly important form of trauma due to the frequent use of firearms and bombs in civilian violence. We report our experience over the past 16 years with missile-induced cardiac injuries.
METHODS
A retrospective study reviewing 40 cases (30 males, 10 females) of missile cardiac injuries was conducted. The nature of injuries, management and outcomes were analyzed.
RESULTS
The ages ranged from 14-68 years. The mean time in which patients reached the hospital was 4.1 hours. Forty percent of the patients had firearm injuries and the remaining 60% had pellet or splinter injuries to the heart. Survival was noted in 37.5% in the gunshot group and in 66.6% in the splinter/pellet group. The survival in patients with isolated cardiac injury was 60%, while it was only 40% in those with associated injuries. Single-chamber injury was noted in 87.5% of the patients and the survival in these was 62.8%. Fourteen complications were noted in the patients who were resuscitated. One patient was re-explored for excessive bleeding and a missed right ventricular perforation was repaired.
CONCLUSION
In missile cardiac injuries, results are best if operated early, and outcome depends upon multiple factors including clinical status at arrival, time interval till management, nature of injury, and associated injuries.

Ateþli Silahlarla Olan Kardiyak Yaralanmalar: 16 Yýllýk Deneyimin Gözden Geçirilmesi

AMAÇ
Sivil toplumdaki þiddet olaylarýnda ateþli silahlarýn ve bombalarýn sýk kullanýlmasý nedeniyle, penetran kardiyak travma, ciddi travma formunu oluþturmaktadýr. Silahlarla oluþan kardiyak yaralanmalarla ilgili olarak 16 yýllýk deneyimimizi bildiriyoruz.
GEREÇ VE YÖNTEM
Ateþli silahla, kardiyak yaralanmalý 40 olguyu (30 erkek, 10 kadýn) gözden geçiren retrospektif bir çalýþma gerçekleþtirildi. Yaralanmalarýn þekli, tedavisi ve sonuçlar deðerlendirildi.
BULGULAR
Olgular 14 ile 68 yaþ arasýnda idi. Hastalarýn hastaneye ulaþtýrýlmasý için geçen ortalama süre 4,1 saat idi. Hastalarýn %40’ý ateþli silah ile yaralanýrken, %60’ý da kalbe gelen saçma veya þarapnel nedeniyle yaralanmýþtý. Kurþun yaralanmasý bulunan grubun %37,5’i hayatta kalýrken, þarapnel/saçma grubunun %66,6’sý hayatta kaldý. Ýzole kardiyak yaralanmasý bulunan hastalardaki saðkalým %60 iken, diðer yaralanmalar da eþlik edenlerde saðkalým yalnýzca %40 oldu. Kalbin tek odacýðýna yönelik yaralanma hastalarýn %87,5’inde kaydedildi ve bu hastalarda saðkalým %62,8 oldu. Resüsite edilen hastalarda 14 komplikasyon kaydedildi. Bir hasta aþýrý kanamaya yönelik olarak yeniden ameliyata alýndý ve gözden kaçmýþ bir sað ventrikül yaralanmasý onarýldý.
SONUÇ
Ateþli silahla kardiyak yaralanmalarda en iyi sonuçlar hastalar erken ameliyata alýndýðýnda elde edilir ve klinik sonuç, hastaneye baþvuru sýrasýndaki klinik durum, tedaviye kadar geçen zaman, yaralanmanýn þekli ve eþlik eden yaralanmalarý da içeren çok sayýda faktöre baðlýdýr.