Principles for the treatment of cardiac injuries: a twenty-two year experience

BACKGROUND: Penetrating cardiac injuries have a rather high mortality and require a rapid diagnosis and emergency surgical intervention. The aim of this study was to present and discuss our experience with penetrating heart wounds. METHODS: Sixteen patients with penetrating cardiac injury underwent surgical treatment at the Department of Cardiovascular Surgery between 1985-2007. The patients ranged in age from 6 to 71 years (mean age 45.1 years). The cause of cardiac injury was stab wounds in 8 patients (50%), iatrogenic reasons in 6 patients (37.5%) and shotgun wounds in 2 patients (12.5%). RESULTS: Exposure to the heart was accomplished by a median sternotomy in 12 patients (75%) and a left-sided anterolateral thoracotomy in 4 patients (25%). The right ventricle (RV) was injured in 7 patients (43.75%), left ventricle (LV) in 3 patients (18.75%), left atrium (LA) in 1 patient (6.25%), LV+LA in 1 patient (6.25%), and coronary arteries in 4 patients (25%). Cardiac wounds were treated by simple suture technique over Teflon or pericardial pledgets in all patients. Two patients died in the early postoperative period. CONCLUSION: The basis for successful management of penetrating cardiac trauma is effective resuscitative measures followed by early detection and definition and emergency surgical treatment of the injury.

Kalp yaralanmalarýnda tedavinin esaslarý: Yirmi iki yýllýk deneyim

AMAÇ: Penetran kalp yaralanmalarý hýzlý taný ve acil cerrahi giriþim gerektiren yüksek düzeyde ölümcül yaralanmalardýr. Bu yazýda, penetran kalp yaralanmalarýna iliþkin deneyimimizi sunmak ve tartýþmak amaçlandý. GEREÇ-YÖNTEM: 1985-2007 yýllarý arasýnda, hastanemizin kalp ve damar cerrahisi kliniðinde penetran kalp yaralanmasý nedeniyle ameliyat edilen 16 olgu geriye dönük olarak deðerlendirildi. Hastalarýn yaþlarý 6 ile 71 arasýnda deðiþiyordu ve yaþ ortalamasý 45,1 idi. Yaralanmanýn etyolojisi; hastalarýn 8’inde (%50) kesici-delici cisim yaralanmasý, 6’sýnda (%37,5) iyatrojenik nedenler ve 2’sinde (%12,5) ateþli silah yaralanmasý idi. BULGULAR: Kalbe ulaþýlmasý, hastalarýn 12’sinde (%75) medyan sternotomiyle, 4’ünde (%25) sol anterolateral torakotomi ile gerçekleþtirildi. Yaralanan bölgeler; olgularýn 7’sinde sað ventrikül (%43,75); 3’ünde sol ventrikül (%18,75), 1’inde sol atriyum (%6,25) ve 1’inde sol ventrikül+sol atriyum (%6,25) idi; 4 olguda (%25) koroner arter yaralanmasý söz konusuydu. Kalp yaralanmalarý, teflon ve perikardiyal yama destekli basit dikiþ tekniði ile onarýldý. Ýki hasta (%12,5) erken dönemde kaybedildi. SONUÇ: Penetran kalp travmasýnýn baþarýlý yönetiminin esasý, etkin destekleyici önlemlerin alýnmasýný izleyerek erken tanýnýn konup kesinleþtirilmesi ve yaralanmanýn acilen cerrahi onarýmýnýn yapýlmasýdýr.