Penetrating cardiac injury: factors affecting outcome

BACKGROUND
Penetrating cardiac injuries are rare but represent a high mortality. Early recognition of the injury and rapid intervention are necessary. We analyzed the characteristics of patients with penetrating injury and the factors affecting the outcome, including the experience of the general surgeon.
METHODS
Twenty-three patients suffering penetrating cardiac injury were retrospectively evaluated in the Istanbul Okmeydaný Training and Research Hospital, Department of General Surgery between 1995 and 2009. Patients with no sign of life on admission were excluded.
RESULTS
All patients were male, and the median age was 25 years. Fifteen patients had left ventricular, 4 had right ventricular and 4 had right atrial injuries; in addition, 2 patients had accompanying intra-abdominal injuries. No coronary vascular injury was reported, and pericardial tamponade did not statistically influence the outcome. Ten of 23 patients suffering of penetrating cardiac injury were lost, and in 6 of the 10 cases, the patient represented the first experience for the operating surgeon.
CONCLUSION
The characteristics of the penetrating cardiac injuries seen in our institution are consistent with the literature. However, we believe that the surgeon’s experience is another prognostic factor. Dedicated level 1 emergency services and trained trauma surgeons are invaluable.

Penetran kalp yaralanmalarý: Sað kalýmý etkileyen faktörler

AMAÇ
Penetran kalp yaralanmalarý nadirdir ancak yüksek mortalite gösterir. Yaralanmalarda erken taný ve hýzlý müdahale gereklidir. Penetran kalp yaralanmasý ile görülen hastalarýn karakteristikleri ve bir eðitim hastanesinde acil hizmeti veren genel cerrahlarýn bireysel tecrübeleri dahil bu hastalarda saðkalýmý etkileyen faktörler irdelendi.
GEREÇ VE YÖNTEM
1995-2009 yýllarý arasýnda Ýstanbul Okmeydaný Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði’nde penetran kalp yaralanmasý nedeni ile tedavi edilen 23 hasta retrospektif kohort olarak analiz edildi. Hastaneye ulaþtýðýnda hayat belirtisi olmayan hastalar çalýþma dýþýnda tutuldu.
BULGULAR
Hastalarýn tamamý erkekti. Median yaþ 25 yýl olarak saptandý. On beþ hastada sol 4 hastada sað ventriküler yaralanma saptandý, 4 hastada sað atriyal yaralanma görülürken, 2 hastada karýn içi yaralanma da eþlik etmekteydi. Hiçbir hastada koroner vasküler yaralanma saptanmadý. Yirmi üç hasta arasýndan 10 hasta kaybedildi, bu hastalardan altýsýnýn bu tip yaralanmalarda ilk tecrübesini yaþayan cerrahlar tarafýndan müdahale gördüðü ön plana çýkmýþtýr. Ayrýca kardiyak tamponad sað kalýmda anlamlý fark oluþturmamýþtýr.
SONUÇ
Kurumumuza görülen penetran kardiyak yaralanma özellikleri literatür ile uyumludur. Bu tip yaralanma oranýnýn nispeten az görüldüðü göz önüne alýndýðýnda travma cerrahisi eðitimi almýþ cerrahlarýn ve kapsamlý travma referans merkezlerinin gerekliliði kaçýnýlmaz olarak gereklidir.