Penetrating Cardiac Injuries: A Historic Perspective and Fascinating Trip Through Time

DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Journal of the American College of Surgeons (Impact Factor: 5.12). 04/2009; 208(3):462-72. DOI: 10.1016/j.jamcollsurg.2008.12.011
Source: PubMed
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Available from: Bruno Monteiro Tavares Pereira
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    • "Penetrating cardiac injuries have been described since ancient times and are still considered a challenge by trauma surgeons because of their lethality and urgency of treatment. By the turn of the past century, treatment had moved from simple clinical observation to surgical intervention and the diagnostic procedures had advanced from a clinical physical examination to include Focused Assessment Sonography for Trauma (FAST), cardiac echocardiogram, and multislice computed tomography scan [1]. Survival rate of penetrating cardiac injuries has increased because of advances in prehospital care (PHC), fast transportation to trauma-referenced facilities, and advances in perioperative trauma surgery. "
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    ABSTRACT: Background: Penetrating traumas, including gunshot and stab wounds, are the major causes of cardiac trauma. Our aim was to describe and compare the variables between patients with penetrating cardiac trauma in the past 20 y in a university hospital, identifying risk factors for morbidity and death. Methods: Review of trauma registry data followed by descriptive statistical analysis comparing the periods 1990-1999 (group 1, 54 cases) and 2000-2009 (group 2, 39 cases). Clinical data at hospital admission, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS) were recorded. Results: The incidences of penetrating cardiac injuries were steady within the period of study in the chosen metropolitan area. The two groups were similar regarding age, mechanism of trauma (gunshot × stab), and ISS. Group 1 showed lower systolic blood pressure at admission (mean 87 versus 109 mm Hg), lower GCS (12.9 versus 14.1), lower RTS (6.4 versus 7.3), higher incidence of grade IV-V cardiac lesions (74% versus 48.7%), and were less likely to survive (0.83 versus 0.93). The major risk factor for death was gunshot wound (13 times higher than stab wound), systolic blood pressure < 90 mm Hg, GCS < 8, RTS < 7.84, associated injuries, grade IV-V injury, and ISS > 25. We observed a tendency in mortality reduction from 20.3% to 10.3% within the period of observation. Conclusions: Several associated factors for mortality and morbidity were identified. In the last decade, patients were admitted in better physiological condition, perhaps reflecting an improvement on prehospital treatment. We observed a trend toward a lower mortality rate.
    Full-text · Article · Mar 2013 · Journal of Surgical Research
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    • "Onehundred and sixteen years ago Alex Cappelen repaired a penetrating injury of the left ventricle through a left anterior thoracotomy in Christiania (former name of Oslo), in one of the world`s least violent countries [1]. Cappelen`s operation is considered to be the first report of a cardiac surgical procedure. "
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    ABSTRACT: A 28-year-old male admitted with a stab wound under his left nipple, underwent emergency surgery because of confusion, a decreasing blood pressure and increasing tachycardia. A median sternotomy incision was made and after establishing cardiopulmonary bypass, a 7 cm wound in the left ventricle and a smaller wound in the left atrium were repaired. An injured segment of lung was resected and the left anterior descending and circumflex arteries were grafted after weaning from cardiopulmonary bypass was initially unsuccessful. Although the patient suffered a stroke, probably due to prehospital hypoperfusion, he eventually recovered without major sequelae. In addition to the case report we present a literature review of the last 15 years pertaining the management of penetrating cardiac injury.
    Full-text · Article · May 2012 · World Journal of Emergency Surgery

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