PENETRATING INJURIES OF THE HEART; PROBLEMS OF DIAGNOSIS AND MANAGEMENT

Abstract

Twelve patients who applied to the Emergency Surgery Unit between 1990-1995 with diagnosis of penetrating cardiac Injury were evaluated in this study.

The mean age of patients was 33.7 (17-64) and female/male ratio was 1/11. The diagnosis was made by the triad of hypotension (<80 mmHg), increase of CVP (>20 cm water) and muffling of heart sounds in 8 patients (67%) and aspiration of defibrinated blood with pericardiosynthesis in 3 patients (25%).

All the patients were injured by stabbing. The right ventricule was injured in 4 patients and left ventricule was injured in 3 patients. The both ventricule was injured in 2 patients.

The myocard was repaired with primary suturing. The pericardium was sutured leaving a hole at either the top and the bottom to avoid retomponade.

Segmenter atelectasis in the inferior lob of the left lung was seen in one patient and empyema developed in the left hemitorax in another patient.

Four patients had been exitus peroperativety. Morbidity was found to be 25% and mortality 33.3%.

According to the data of literature and to results of our study, we conclude that it is appropriate to make toracotomy and to perform primary closure of the heart wound after fluid replacement and resuscitation.