Management of Penetrating Wounds of The Heart

Volume 8, Issue 10, October – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Management of Penetrating Wounds of the Heart

Hafedh DALY
Corresponding author
Gafsa Regional Hospital, Tunisia
Abstract :- Objective: The objective of the work was to The qualitative variables of our study were expressed
define the particularities of surgical management of as percentages and numbers, while the quantitative variables
patients with heart wounds. were expressed as means +/- standard deviations.
Patients and method: This was a retrospective study of
patients suffering from heart wounds and treated in a III. RESULTS
cardiovascular surgery department between 2014 and
2022. The data studied were the site of the lesions, the This was a series of 12 patients suffering from a stab wound
treatment times. load, preoperative clinical and to the heart (11 men and 1 woman), average age 32 ± 14.7
paraclinical data, surgical technique and mortality. years.
Results: Twelve patients (11 men/1 woman) with a mean The treatment time between the trauma and arrival in
age of 32 ± 14.7 years. The average surgical treatment the cardiovascular surgery unit was 52.5 ± 31 min. 11
time was 52.5 ± 31 min. Two patients underwent median patients presented with collapse before arriving at cardiac
sternotomy, one via subxiphoid approach and nine via surgery defined as a systolic blood pressure less than 90 mm
thoracotomy. Right ventricular injury was observed in Hg and a heart rate greater than 120/min. Six patients had a
10 patients. Treatment was surgical in all patients. chest CT scan which revealed pericardial effusion each time.
Conclusion: This is a serious emergency. The treatment
is surgical, the approach depends on the site of the chest Six patients were taken to the operating room straight
wound. The prognosis varies depending on the time it away. The approach was a subxiphoid Marfan approach
takes to receive treatment. once, a median sternotomy twice and an anterolateral
thoracotomy nine times.
Keywords:- Heart Wound, Sternotomy, Thoracotomy,
Surgery. LV injury occurred in two patients (16.7%) and RV
injury in ten patients (83.3%). There were no wounds in the
I. INTRODUCTION left atrium, right atrium, coronary arteries or great vessels.
Finally, four times we found a pulmonary parenchymal
Heart injuries are a surgical emergency, the prognosis wound associated with an intrapericardial lesion.
of which depends on the initial treatment, the mechanism of
the injury, and the hemodynamic state of the patient when All lesions were treated with a beating heart by simple
help arrives (1). Despite progress made in pre-hospital care myoraphy using separate points with 5/0 prolene or
and diagnosis, mortality remains high. They generally result supported on a dacron patch (one case).
from a gunshot or stab wound; more rarely, rib fractures can
be responsible for pericardial lesions. When the diagnosis is The postoperative course was simple for all patients,
made, treatment is based on emergency surgery. we reported no deaths and the average length of stay in the
cardiovascular surgery unit was 11.5 ± 3 days.
II. PATIENTS AND METHODS
IV. DISCUSSION
This is a retrospective study extended over a period of
8 years, between January 2014 and December 2022, about Ten percent of chest trauma is responsible for heart
12 patients presenting with a heart wound, and having been damage. The etiology is most often a firearm or stab wound;
treated within the cardiovascular surgery department of the closed trauma and iatrogenic wounds are rarer (2).
Gafsa regional hospital.
There is a contrast between pre-hospital mortality and
All data used in our work were collected from the that of patients arriving living in a hospital structure. Thus,
patient files of the cardiovascular surgery department of the in an autopsy series of heart wounds, 87% of deaths
Gafsa regional hospital. occurred at the scene of the trauma, most often related to
hemorrhagic shock (3). On the other hand, in retrospective
The collection of data in medical files was done in series of operated patients, mortality can be less than 20%,
ascending chronological order from January 2014 to particularly for stab wounds. The prognostic factors are: a
December 2022, using operating records. short time to surgical treatment; the young age of the
patient; the absence of associated lesion or comorbidity; and
For the statistical study, we reported all the data on an the existence of a preoperative tamponade chart (4). The
Excel table and we used the SPSS 23 software. series we present has epidemiological characteristics
IJISRT23OCT1619 www.ijisrt.com 1744

Volume 8, Issue 10, October – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
comparable to those in the literature, with a majority of [4]. Degiannis E, Loogna P, Doll D, Bonanno F, Bowley
young men presenting stab wounds to the right cavities. DM, Smith MD. Penetrating cardiac injuries: recent
experience in South Africa. World J Surg
In our series, 6 out of 12 patients had a chest CT scan 2006;30:1258-1264.
upon arrival and no patient had a cardiac ultrasound. Given [5]. Nagy KK, Lohmann C, Kim DO, Barrett J. Role of
its availability in our department, performing a chest CT echocardiography in the diagnosis of occult penetrating
scan has never delayed surgical treatment. Cardiac cardiac injury. J Trauma 1995;38:859-862.
ultrasound, which can be repeated on demand, is the test of [6]. Lang-Lazdunski L, Chapuis O, Pons F, Jancovici R.
choice in the management of cardiac trauma. For the Videothoracospy in thoracic trauma and penetrating
diagnosis of pericardial effusion, its sensitivity is 96%, its injuries. Ann Chir 2003;128:75-80.
specificity and its positive predictive value are 100% (5). In [7]. Navsari PH, Nicol AJ. Haemopercardium in stable
case of doubt about a penetrating lesion of the cardiac area, patients after pentrating injury: is subxiphoid
an intermediate approach between monitoring and surgical pericardial window and drainage enough? A
exploration by sternotomy or thoracotomy may be prospective study. Injury 2005;36:745-750.
thoracoscopy. This minimally invasive method has the [8]. Asensio JA, Berne JD, Demetriades D et al. One
advantage of being able to diagnose a heart wound, to be hundred five penetrating cardiac injuries: a 2-year
able to assess the associated intra-thoracic lesions on the prospective evaluation. J Trauma 1998;44:1073-1082.
side of the lesion and finally to determine the best approach [9]. Avaro J-P, D’journo X-B, Trousse D, Roch A, Thomas
if a surgical procedure is required. 'imposes (6). Other P, Doddoli C. Le traumatisme thoracique grave aux
authors have been able to propose surgical pericardial urgences, stratégie de prise en charge initiale.
drainage using the Marfan route in stable patients who do Réanimation 2006;15:561-67.
not present signs of active hemorrhage at the time of [10]. Vasquez JC, Baciewicz FA Jr. Late onset angina after
treatment (7). penetrating cardiac injury adjacent to a coronary artery.
J trauma 2006;60:1344-6.
However, in the majority of cases the notion of trauma [11]. Makaryus AN, Manetta F, Goldner B, Stephen B,
to the cardiac area and the existence of pericardial effusion Rosen SE, Park CH. Large left ventricular
justify systematic surgical exploration (8,9). pseudoaneurysm presenting 25 years after
penetrating chest trauma. J Interv Cardiol
The surgical technique for repairing heart wounds is 2005;18:193-200.
not very specific. This is a myoraphy with separate points,
supported or not on synthetic or pericardial strips, the
imperative of which is to ensure perfect hemostasis of the
damaged cardiac cavities. The morbidity linked to this
procedure is low and we have never had any immediate
complications. In the long term, we find in the literature a
case of coronary stenosis with angina and a case of
pseudoaneurysm of the left ventricle (10,11).
V. CONCLUSION
Heart injuries have a high pre-hospital mortality but

patients arriving alive at the hospital a priori present simple
cardiac lesions which can be treated by cardiomyoraphy
with very good results. The use of extracorporeal circulation
remains exceptional. The most determining prognostic
factor is the delay in surgical treatment.
REFERENCES
[1]. Thourani VH, Feliciano DV, Cooper WA et al.

Penetrating cardiac trauma at an urban trauma center: a
22-year perspective. Am Surg 1999;65:811-816. Fig 1: Right ventricular wound operated by median
[2]. Orliaguet G, Riou B. Lésions traumatiques du cœur. sternotomy
Medecine d’urgence 2002 : 71-86.
[3]. Fedakar R, Turkmen N, Durak D, Gundogmus UN.
Fatal traumatic heart wounds: review of 160 autopsy
cases. Isr Med Assoc J 2005;7:498-501.
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Volume 8, Issue 10, October – 2023 International Journal of Innovative Science and Research Technology

Management of Penetrating Wounds of the Heart

IJISRT23OCT1619 www.ijisrt.com 1744

Heart injuries have a high pre-hospital mortality but

[1]. Thourani VH, Feliciano DV, Cooper WA et al.

IJISRT23OCT1619 www.ijisrt.com 1745

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