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DOI: 10.1055/s-0029-1240921
© Georg Thieme Verlag KG Stuttgart · New York
Management of Stab Wounds of the Heart: Analysis of 73 Cases in 10 Years
Publikationsverlauf
received August 4, 2009
Publikationsdatum:
31. Mai 2010 (online)
![](https://www.thieme-connect.de/media/thoracic/201004/lookinside/thumbnails/10.1055-s-0029-1240921-1.jpg)
Abstract
Background: Stab wounds of the heart still cause a significant number of traumatic deaths every year. The aim of this study was to assess the outcome of patients with cardiac stab wounds requiring emergency thoracotomy. Patients and Methods: Preoperative and operative variables were reviewed for all patients treated at the Mansoura Emergency Hospital between August 1998 and July 2008. Results: Seventy-three patients were treated for stab wounds of the heart. Of these 69 were male (94.5 %) and only 4 were female (5.5 %). Mean patient age was 28.5 ± 5.8 years. The clinical status was stable in 22 patients (30.1 %) and unstable in 26 patients (35.6 %), while 10 patients were in shock (13.7 %), and 15 patients had suffered cardiac arrest prior to thoracotomy (20.6 %). Emergency room (ER) thoracotomy was performed in 18 patients (24.7 %) and operative room (OR) thoracotomy was carried out in 55 patients (75.3 %). The commonest location of stab wounds to the heart was the right ventricle in 28 patients (38.4 %) followed by the left ventricle in 25 patients (34.2 %). Mortality was 23.3 % (17 patients), and morbidity was 21.4 % (12 patients out of 56 surviving patients). Prognostic factors included clinical status (patients in shock or cardiac arrest had a mortality rate of 50 % and 60 %, respectively), cardiopulmonary resuscitation (CPR; mortality rate: 68.2 %) and ER thoracotomy (mortality rate: 66.7 %). Conclusion: Clinical status as shock, CPR and ER thoracotomy were prognostic of a poor outcome and associated with high mortality rates.
Key words
stab wound - heart - prognostic factor
References
- 1 Keçeligil H T, Bahcivan M, Demirağ M K, Celik S, Kolbakir F. Principles for the treatment of cardiac injuries: a twenty-two year experience. Ulus Travma Acil Cerrahi Derg. 2009; 15 (2) 171-175
- 2 Crawford C M, Alam G A. Delayed cardiac tamponade in a patient with penetrating chest trauma. J Emerg Med. 1997; 15 (1) 31-33
- 3 Karin E, Greenberg R, Avital S, Aladgem D, Kluger Y. The management of stab wounds to the heart with laceration of the left anterior descending coronary artery. Eur J Emerg Med. 2001; 8 321-323
- 4 Blake D P, Gisbert V L, Ney A L, Helscth H K, Plummer D W, Ruiz E, Bubrick M P. Survival after emergency department versus operating room thoracotomy for penetrating cardiac injuries. Am Surg. 1992; 58 329-333
- 5 Baker C C, Thomas A N, Trunkey D D. The role of emergency room thoracotomy in trauma. J Trauma. 1980; 20 848-855
- 6 Ivatury R R, Nallathambi M N, Rohman M. Penetrating cardiac trauma. Ann Surg. 1987; 205 61-66
- 7 Buchman T G, Phillips J, Menker J B. Recognition, resuscitation, and management of patients with penetrating cardiac injuries. Surg Gynecol Obstet. 1992; 174 205-210
- 8 Ozyazicioglu A, Ates A, Ceviz M, Karapolat S, Bozkurt E, Kocak H. Penetrating cardiac injuries. Turk J Med Sci. 2002; 32 499-503
- 9 Baxter T, Moore E B, Moore J B, Cleveland H C, McCroskey B L, Moore F A. Emergency department thoracotomy following injury: critical determinants for patient salvage. World J Surgery. 1988; 12 671-675
- 10 Attar S, Suter C M, Hankins J R, Sequeira A, McLaughlin J S. Penetrating cardiac injuries. Ann Thorac Surg. 1991; 51 711-716
- 11 Tokcan A, Kisacikoglu B, Salih O K, Usul T, Tansal S, Oskay M K. Penetrating cardiac injuries: An analysis of 66 cases. J Islamic Acad Sci. 1990; 3 (1) 62-65
- 12 Aoki K, Watanabe M, Ohzeki H. Resuscitation using percutaneous cardiopulmonary support and beating heart surgery with balloon technique for a patient with penetrating cardiac injury. Kyobu Geka. 2008; 61 (12) 1015-1018
- 13 Arreola-Risa C, Rhee P, Boyle E M, Maier R V, Jurkovich G G, Foy H M. Factors influencing outcome in stab wounds of the heart. Am J Surg. 1995; 169 (5) 553-556
- 14 Beck C S. Two cardiac compression triads. JAMA. 1935; 104 (9) 714-716
- 15 Seamon M J, Fisher C A, Gaughan J P, Kulp H, Dempsey D T, Goldberg A J. Emergency department thoracotomy: survival of the least expected. World J Surg. 2008; 32 (4) 604-612
- 16 Gunay C, Cingoz F, Kuralay E, Demirkilic U, Tatar H. Surgical challenges for urgent approach in penetrating heart injuries. Heart Surg Forum. 2007; 10 (6) E473-E477
- 17 Tyburski J G, Astra L, Wilson R F, Dente C, Steffes C. Factors affecting prognosis with penetrating wounds of the heart. J Trauma. 2000; 48 587
- 18 Wall M J, Mattox K L, Baldwin J C. Acute management of complex cardiac injuries. J Trauma. 1997; 42 905-912
- 19 Karrel R, Shaffer M A, Franaszek J B. Emergency diagnosis, resuscitation, and treatment of acute penetrating cardiac trauma. Ann Emerg Med. 1982; 11 504-517
- 20 Velmahos G C, Degiannis E, Souter I, Sandia R. Penetrating trauma to the heart: a relatively innocent injury. Surgery. 1994; 115 694-697
- 21 Asensio J A, Berne J D, Demetriacjes D. One hundred and five penetrating cardiac injuries: a 2-year prospective evaluation. J Trauma. 1998; 44 1073-1082
- 22 Barton E D, Jacoby A. Stab wound to the chest with acute pericardial tamponade. J Emerg Med. 1996; 14 (6) 743-745
- 23 Bockerja L A, Ali H. Successful surgical management of penetrating heart injury due to bomb explosion in a child. Interact Cardiovasc Thorac Surg. 2005; 4 281-282
- 24 Nagy K K, Lohmann C, Kim D O, Barrett J. Role of echocardiography in the diagnosis of occult penetrating cardiac injury. J Trauma. 1995; 38 859-862
- 25 Harris D G, Janson J T, Van Wyk J, Pretorius J, Rossouw G J. Delayed pericardial effusion following stab wounds to the chest. Eur J Cardiothorac Surg. 2003; 23 473-476
Noureldin Noaman Gwely, MD, Assistant Professor of Cardiothoracic Surgery
Mansoura Faculty of Medicine
Mansoura 2205
Egypt
Telefon: +20 5 02 32 09 92
Fax: +20 5 02 26 54 71
eMail: dr.noureldin_noaman@yahoo.com