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Thorac Cardiovasc Surg 2010; 58(4): 210-214
DOI: 10.1055/s-0029-1240921
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Management of Stab Wounds of the Heart: Analysis of 73 Cases in 10 Years

N. N. Gwely1 , A. Mowafy1 , S. Khalaf1 , S. Amer1 , U. Hamza1 , M. El-Saeed1
  • 1Cardiothoracic Surgery, Mansoura Faculty of Medicine, Mansoura, Egypt
Further Information

Publication History

received August 4, 2009

Publication Date:
31 May 2010 (online)

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Abstract

Background: Stab wounds of the heart still cause a significant number of traumatic deaths every year. The aim of this study was to assess the outcome of patients with cardiac stab wounds requiring emergency thoracotomy. Patients and Methods: Preoperative and operative variables were reviewed for all patients treated at the Mansoura Emergency Hospital between August 1998 and July 2008. Results: Seventy-three patients were treated for stab wounds of the heart. Of these 69 were male (94.5 %) and only 4 were female (5.5 %). Mean patient age was 28.5 ± 5.8 years. The clinical status was stable in 22 patients (30.1 %) and unstable in 26 patients (35.6 %), while 10 patients were in shock (13.7 %), and 15 patients had suffered cardiac arrest prior to thoracotomy (20.6 %). Emergency room (ER) thoracotomy was performed in 18 patients (24.7 %) and operative room (OR) thoracotomy was carried out in 55 patients (75.3 %). The commonest location of stab wounds to the heart was the right ventricle in 28 patients (38.4 %) followed by the left ventricle in 25 patients (34.2 %). Mortality was 23.3 % (17 patients), and morbidity was 21.4 % (12 patients out of 56 surviving patients). Prognostic factors included clinical status (patients in shock or cardiac arrest had a mortality rate of 50 % and 60 %, respectively), cardiopulmonary resuscitation (CPR; mortality rate: 68.2 %) and ER thoracotomy (mortality rate: 66.7 %). Conclusion: Clinical status as shock, CPR and ER thoracotomy were prognostic of a poor outcome and associated with high mortality rates.

Key words

stab wound - heart - prognostic factor

References

  • 1 Keçeligil H T, Bahcivan M, Demirağ M K, Celik S, Kolbakir F. Principles for the treatment of cardiac injuries: a twenty-two year experience.  Ulus Travma Acil Cerrahi Derg. 2009;  15 (2) 171-175
    PubMedGoogle Scholar
  • 2 Crawford C M, Alam G A. Delayed cardiac tamponade in a patient with penetrating chest trauma.  J Emerg Med. 1997;  15 (1) 31-33
    CrossrefPubMedGoogle Scholar
  • 3 Karin E, Greenberg R, Avital S, Aladgem D, Kluger Y. The management of stab wounds to the heart with laceration of the left anterior descending coronary artery.  Eur J Emerg Med. 2001;  8 321-323
    CrossrefPubMedGoogle Scholar
  • 4 Blake D P, Gisbert V L, Ney A L, Helscth H K, Plummer D W, Ruiz E, Bubrick M P. Survival after emergency department versus operating room thoracotomy for penetrating cardiac injuries.  Am Surg. 1992;  58 329-333
    PubMedGoogle Scholar
  • 5 Baker C C, Thomas A N, Trunkey D D. The role of emergency room thoracotomy in trauma.  J Trauma. 1980;  20 848-855
    CrossrefPubMedGoogle Scholar
  • 6 Ivatury R R, Nallathambi M N, Rohman M. Penetrating cardiac trauma.  Ann Surg. 1987;  205 61-66
    CrossrefPubMedGoogle Scholar
  • 7 Buchman T G, Phillips J, Menker J B. Recognition, resuscitation, and management of patients with penetrating cardiac injuries.  Surg Gynecol Obstet. 1992;  174 205-210
    PubMedGoogle Scholar
  • 8 Ozyazicioglu A, Ates A, Ceviz M, Karapolat S, Bozkurt E, Kocak H. Penetrating cardiac injuries.  Turk J Med Sci. 2002;  32 499-503
    PubMedGoogle Scholar
  • 9 Baxter T, Moore E B, Moore J B, Cleveland H C, McCroskey B L, Moore F A. Emergency department thoracotomy following injury: critical determinants for patient salvage.  World J Surgery. 1988;  12 671-675
    CrossrefPubMedGoogle Scholar
  • 10 Attar S, Suter C M, Hankins J R, Sequeira A, McLaughlin J S. Penetrating cardiac injuries.  Ann Thorac Surg. 1991;  51 711-716
    CrossrefPubMedGoogle Scholar
  • 11 Tokcan A, Kisacikoglu B, Salih O K, Usul T, Tansal S, Oskay M K. Penetrating cardiac injuries: An analysis of 66 cases.  J Islamic Acad Sci. 1990;  3 (1) 62-65
    PubMedGoogle Scholar
  • 12 Aoki K, Watanabe M, Ohzeki H. Resuscitation using percutaneous cardiopulmonary support and beating heart surgery with balloon technique for a patient with penetrating cardiac injury.  Kyobu Geka. 2008;  61 (12) 1015-1018
    PubMedGoogle Scholar
  • 13 Arreola-Risa C, Rhee P, Boyle E M, Maier R V, Jurkovich G G, Foy H M. Factors influencing outcome in stab wounds of the heart.  Am J Surg. 1995;  169 (5) 553-556
    CrossrefPubMedGoogle Scholar
  • 14 Beck C S. Two cardiac compression triads.  JAMA. 1935;  104 (9) 714-716
    PubMedGoogle Scholar
  • 15 Seamon M J, Fisher C A, Gaughan J P, Kulp H, Dempsey D T, Goldberg A J. Emergency department thoracotomy: survival of the least expected.  World J Surg. 2008;  32 (4) 604-612
    CrossrefPubMedGoogle Scholar
  • 16 Gunay C, Cingoz F, Kuralay E, Demirkilic U, Tatar H. Surgical challenges for urgent approach in penetrating heart injuries.  Heart Surg Forum. 2007;  10 (6) E473-E477
    CrossrefPubMedGoogle Scholar
  • 17 Tyburski J G, Astra L, Wilson R F, Dente C, Steffes C. Factors affecting prognosis with penetrating wounds of the heart.  J Trauma. 2000;  48 587
    CrossrefPubMedGoogle Scholar
  • 18 Wall M J, Mattox K L, Baldwin J C. Acute management of complex cardiac injuries.  J Trauma. 1997;  42 905-912
    CrossrefPubMedGoogle Scholar
  • 19 Karrel R, Shaffer M A, Franaszek J B. Emergency diagnosis, resuscitation, and treatment of acute penetrating cardiac trauma.  Ann Emerg Med. 1982;  11 504-517
    CrossrefPubMedGoogle Scholar
  • 20 Velmahos G C, Degiannis E, Souter I, Sandia R. Penetrating trauma to the heart: a relatively innocent injury.  Surgery. 1994;  115 694-697
    PubMedGoogle Scholar
  • 21 Asensio J A, Berne J D, Demetriacjes D. One hundred and five penetrating cardiac injuries: a 2-year prospective evaluation.  J Trauma. 1998;  44 1073-1082
    CrossrefPubMedGoogle Scholar
  • 22 Barton E D, Jacoby A. Stab wound to the chest with acute pericardial tamponade.  J Emerg Med. 1996;  14 (6) 743-745
    CrossrefPubMedGoogle Scholar
  • 23 Bockerja L A, Ali H. Successful surgical management of penetrating heart injury due to bomb explosion in a child.  Interact Cardiovasc Thorac Surg. 2005;  4 281-282
    CrossrefPubMedGoogle Scholar
  • 24 Nagy K K, Lohmann C, Kim D O, Barrett J. Role of echocardiography in the diagnosis of occult penetrating cardiac injury.  J Trauma. 1995;  38 859-862
    CrossrefPubMedGoogle Scholar
  • 25 Harris D G, Janson J T, Van Wyk J, Pretorius J, Rossouw G J. Delayed pericardial effusion following stab wounds to the chest.  Eur J Cardiothorac Surg. 2003;  23 473-476
    CrossrefPubMedGoogle Scholar

Noureldin Noaman Gwely, MD, Assistant Professor of Cardiothoracic Surgery

Mansoura Faculty of Medicine

Mansoura 2205

Egypt

Phone: +20 5 02 32 09 92

Fax: +20 5 02 26 54 71

Email: dr.noureldin_noaman@yahoo.com

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