Penetrating injuries of the heart

This study represents a review of 33 patients seen at the Kingston Public Hospital, Jamaica, with penetrating cardiac injuries over a 7-year period from 1982 to 1989. Male patients between the ages of 12 and 30 years accounted for more than 80 per cent of cases. A history of syncope associated with haemodynamic instability were the predominant clinical features on presentation. The clinical triad of raised central venous pressure, muffled heart sounds, and low blood pressure levels was present in 33 per cent of the patients with cardiac tamponade. Pulsus paradoxus was not a significant diagnostic sign. Most of the injuries were stab wounds to the left anterior chest. The most commonly injured heart chamber was the right ventricle (48 per cent). Pericardiocentesis was no helpful in making the diagnosis and was only performed as a resuscitative measure in unstable patients prior to thoracotomy. Cardiorrhaphy was performed in the majority of patients through a left anterior lateral thoracotomy with median strnotomy being used only for suspected hilar injuries. A high index of suspicion in patients with penetrating thoracic trauma with expeditious thoracotomy will result in the greatest salvage rate (AU)

Penetrating injuries of the heart - abstract

This study represents a review of 33 patients seen at the Kingston Public Hospital, Jamaica, with penetrating cardiac injuries over a 7-year period from 1982 to 1989. Male patients between the ages of 12 and 30 years accounted for more than 80 per cent of cases. A history of syncope associated with haemodynamic instability were the predominant clinical features on presentation. The clinical triad of raised central venous pressure, muffled heart sounds, and low bloodpressure was present in 33 per cent of the patients with cardiac tamponade. Plus paradoxus was not a significant diagnostic sign. Most of the injuries were stab wounds to the left anterior of the chest. The most commonly injured heart chamber was the right ventricle (48 per cent). Pericardiocentesis was not helpful in making the diagnosis and was only performed as a resuscitative measure in unstable patients prior to thoracotomy. Cardiorrhaphy was performed in the majority of patients through a left anterior lateral thoracotomy with median sternotomy being used only for suspected hilar injuries. A high index of suspicion in patients with penetrating thoracic trauma with expeditious thoracotomy will result in the greatest salvage rate (AU)

Intrapericardial heart and great vessel injuries

Eighteen patients with intrapericardial penetrating injuries of the heart or great vessels are reviewed, and the results compared with other published material. The majority presented with injuries of the left anterior chest wall and with clinical evidence of cardiac tamponade. Most of the injuries resulted from stab wounds, and there were two deaths which occurred in the immediate peri-operative period. The importance and clinical recognition of cardiac tamponade is stressed. Immediate thoracotomy and repair of the cardiac wound is advocated, and pericardiocentesis is recommended only as a temporary measure to allow transportation of the patient to definitive care. (AU)