Major thoracic vessels and cardiac trauma: case series from a center in a developing country

Seventy-five percent of all trauma-related deaths are related to thoracic trauma. Very few penetrating cardiac trauma patients arrive to the hospital alive. Due to its high prevalence, an understanding of the pathogenesis, manifestations and management of cardiac trauma by the medical personnel is becoming increasingly important.

We retrospectively reviewed the files of 169 patients with a preoperative diagnosis of vascular injury who underwent management at the Aga Khan University Hospital from 2001 to 2006. Of these patients, 13 had cardiovascular and cardiac injuries.

23% (n=3) had cardiac injuries; 2 had right ventricle injuries and 1 had injury to both ventricles. Great vessel injuries included: pulmonary artery (n=2), inferior vena cava (n=1), left carotid artery (n=1), left subclavian artery (n=2), and right subclavian artery (n=3). 53.8% of the patients suffered from postoperative complications. The overall mortality of patients with major thoracic vessel and cardiac trauma was found to be 15.4%.

We believe that, in the past, the inevitable delay in diagnosis led to unsuccessful thoracotomies, late transfers to the operating room and physiological deterioration of the patient. As the incidence of trauma is increasing worldwide, it is essential for surgeons to be prepared to handle cardiovascular and cardiac trauma injuries immediately, as delay can adversely affect the outcome in terms of both morbidity and mortality. All patients presenting with trauma to the chest should be assessed with a high index of suspicion for major cardiovascular injuries. Early diagnosis, prompt transfer to the operating room and speedy and perfect surgery influence a favorable outcome.