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Profile of missile-induced cardiovascular injuries in Kashmir, India
Mohd Lateef Wani1, Abdul Gani Ahangar, Gh Nabi Lone
1Department of Thoracic Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.
Insights
Missile cardiovascular injuries are a significant concern, requiring prompt surgical intervention. Early management of cardiac and vascular trauma improves patient outcomes and reduces complications like infection and amputation.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Ballistics Medicine
Background:
- Missile cardiovascular injuries have become epidemic in Kashmir since 1990.
- Analysis of injury patterns, presentation, and management is crucial.
Purpose of the Study:
- To analyze the pattern, presentation, and management of missile cardiovascular injuries.
- To evaluate outcomes and identify factors influencing mortality and morbidity.
Main Methods:
- Retrospective study of 386 patients with missile cardiovascular injuries (Jan 1996 - Oct 2008).
- Exclusion of non-missile cardiovascular injuries.
- Analysis of surgical approaches and complications.
Main Results:
- Right ventricle most commonly injured; primary cardiorrhaphy used for cardiac injuries.
- Left anterior thoracotomy was the most common surgical approach.
- Vascular injuries treated with saphenous vein grafts or anastomosis; wound infection (20.83%) and graft occlusion (1.94%) were common complications. Amputation rate was 4.66%.
Conclusions:
- Early surgical intervention for missile cardiac injuries is vital.
- Prompt resuscitation and revascularization are critical for missile vascular injuries.
- Timeliness of treatment and associated injuries significantly impact mortality and morbidity.
Background:
Missile cardiovascular injuries have taken an epidemic proportion in Kashmir valley since the eruption of militancy in 1990. Present study was undertaken to analyse the pattern, presentation and management of missile cardiovascular injuries.
Patients And Methods:
Three hundred and eighty-six patients with missile cardiovascular injuries since Jan 1996 to Oct 2008 were studied retrospectively. All patients of cardiovascular injuries due to causes other than missiles were excluded from the study.
Results:
All patients of missile cardiac injuries were treated by primary cardiorrhaphy. Right ventricle was the most commonly affected chamber. Left anterior thoracotomy was most common approach used. Most of the patients of missile vascular group were treated by reverse saphenous vein graft or end-to-end anastomosis. Most common complication was wound infection (20.83%) followed by graft occlusion (1.94%) in missile vascular group. Amputation rate was 4.66%. Amputation rate was higher in patients with delay of >6 hours and associated fractures.
Conclusion:
Missile cardiac injuries should be operated early without wasting time for investigations. Clinical status at arrival, time interval till management, nature of injury and associated injuries, tell upon the mortality. Missile vascular injury needs prompt resuscitation and revascularization at the earliest. Time interval till revascularization and associated fractures has a bearing on mortality and morbidity.
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