[Diagnosis and surgical strategy in injuries of the heart and pericardium]

Results of the emergency diagnosis and surgical treatment of wounds of the heart and pericardium were summed up in 207 wounded during twenty years of work. It was found that injuries of the heart and pericardium were diagnosed in 42% of cases according to clinical symptoms, while emergency thoracotomy during the first minutes after admission to the surgical hospital was performed in 55-60% of wounded to the heart. About half wounded at the moment of admission to the hospital were at the state of relative stabilization of hemodynamic indices and had no clinical symptoms of wounds to the heart. In this group of patients injuries of the heart and pericardium were diagnosed on the basis of additional investigations, extrapleural pericardiotomy (fenestration of the pericardium) being most reliable. The results of treatment of wounded to the heart can be improved at the expense of acute surgical strategy which is determined by the stable state of the wounded, character of the myocardium injury and associated wounds.