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Thoracic Penetrating Wounds with Cardiac Injury: A Single-Center Experience
Insights
Penetrating cardiac injury management has evolved, but remains a significant challenge. Successful cardiac suture is key to survival, with outcomes tied to injury severity and blood loss.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Cardiovascular Surgery
Background:
- Penetrating cardiac injury presents ongoing management challenges despite advancements.
- Cardiac trauma remains a critical medical issue requiring effective treatment protocols.
Purpose of the Study:
- To analyze management strategies and outcomes for patients with penetrating cardiac injuries.
- To identify factors influencing survival and mortality in cardiac trauma cases.
Main Methods:
- Retrospective case series of 41 patients with precordial wounds (2005-2020).
- Inclusion of preoperative diagnostics (ECG, X-ray, FAST, etc.) and surgical approaches.
- Analysis of injury types, associated intrathoracic lesions, and patient outcomes.
Main Results:
- 87.8% of patients were hemodynamically unstable; 52.8% required immediate surgery.
- Right ventricle was the most frequently injured chamber; 70.7% had additional intrathoracic injuries.
- Mortality rate was 17.1%, with survival linked to successful cardiac repair.
Conclusions:
- Successful cardiac suture significantly improves survival rates (82.9%).
- Lethality correlates with cardiac injury severity, blood loss volume, and specific chamber damage (right vs. left).
Abstract:
Background: Management protocols for patients with penetrating cardiac injury have undergone a dramatic transition during the last decades. However, even today cardiac trauma remains a major medical problem. Methods: Retrospective single-center case series study, 41 patients with precordial wounds hospitalized at the Institute of Emergency Medicine, Chisinau, period 2005-2020. Mean age - 45.8 Ã+- 8.9 years, M:F/19.5:1. Traumatic event: stabbing (82.9%,n=34) or gunshot wound (17.1%,n=7). Preoperative paraclinical examinations: electrocardiography, chest X-ray, FAST, pleurotomy, pericardial puncture, and thoracoscopy. Results: 36 (87.8%) patients were hemodynamically unstable on hospitalization, and 19 (52.8%) were immediately transferred to the operating room. Preferred surgical access: left anterolateral thoracotomy - 26 (63.4%), right anterolateral thoracotomy - 13 (31.7%), and left posterolateral thoracotomy - 2 (4.9%). Non-penetrating lesions were discovered in 5 (12.2%) while penetrating trauma in other 36 (87.8%) cases, most frequently the right ventricle being injured. Additional intrathoracic lesions discovered in 29 (70.7%) patients: pulmonary parenchyma rupture - 25 (86.2%), internal mammary artery injury - 3 (10.3%), and intercostal artery injury - 1 (3.5%). The average length of stay was 13.2 Ã+- 4 days, including stay in the Intensive Care Unit - 2.9 Ã+- 1.2. Mortality rate -17.1% (n=7). Conclusions: Successful cardiac suture determined the survival rate of 82.9%. Lethality increases proportionally to the severity of the cardiac injury, the volume of blood loss, and damage to the right vs left heart chambers.
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