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Penetrating cardiac injury--to close the pericardium or not? A case report

K O Taams1, J A Mayor-Davies

  • 1Department of Surgery, Hillbrow Hospital, Johannesburg.

South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
|June 1, 1992
PubMed

Insights

Trauma surgeons often leave the pericardium open after heart repair, risking fatal bleeding if the heart adheres to the sternum. Closing the pericardium in trauma cases can prevent complications and aid future mediastinal surgeries.

Area of Science:

  • Cardiothoracic surgery
  • Trauma surgery
  • Pericardial closure

Background:

  • Penetrating cardiac injuries are common in trauma settings.
  • Routine closure of the pericardium after cardiac repair is not standard practice.
  • Adhesions between the heart and sternum can form when the pericardium is left open.

Observation:

  • A patient died from exsanguination due to adhesions between the heart and sternum after a penetrating cardiac injury.
  • Mobilizing the adhered heart during surgery proved fatal.
  • The pericardium was not sutured closed in this trauma case.

Findings:

  • Failure to close the pericardium can lead to adhesions.
  • These adhesions pose a significant risk during subsequent surgical interventions requiring mediastinal access.
  • Exsanguination is a potential fatal complication.

Implications:

  • Closing the pericardium in trauma settings is recommended.
  • Pericardial closure facilitates future cardiac and mediastinal surgeries.
  • This practice can prevent fatal complications like exsanguination.

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