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Surgical Management of Penetrating Cardiac Trauma Patients

Yıl 2018, Cilt: 21 Sayı: 2, 111 - 116, 19.08.2018

Öz

Introduction:
Penetrating
traumas, including gunshot and stab wounds, are the major causes of cardiac
trauma. The aim of this study was to evaluate the diagnosis and surgical
treatment in penetrating cardiac trauma patients.



Patients
and Methods:
Forty-eight patients who underwent surgery for
penetrating cardiac trauma between February 2009 and May 2017 were reviewed
retrospectively. Transthoracic echocardiography, computed tomography
angiography, and laboratory studies were performed if the patient was hemodynamically
stable. 



Results: A total of
48 patients (45 males, 3 females; mean age 29.4 ± 11.1 years,
range 16-51 years) were operated. Etiology was stab wound injury in 46
(95.8%) patients. Twenty-nine (60.4%) patients were in cardiogenic shock. In 44
cases, median sternotomy was performed. The most affected cardiac chamber was
the right ventricle in 28 (58.3%) patients. The most common accompanying organ
injury was the lungs with 15 patients. The mortality rate was 27.1% with 13
patients. Hemodynamic status of the patient, requirement of preoperative CPR,
and preoperative hematocrit levels were found to have a significant effect on
mortality.



Conclusion: In penetrating cardiac
trauma, early diagnosis and emergency surgery will improve overall survival rates.
The hemodynamic status of patients on arrival have significant effect on
prognosis.

Kaynakça

  • 1. Yavuz C, Çil H, Başyiğit İ, Demirtaş S, İslamoğlu Y, Tekbaş G, et al. Factors affecting mortality in penetrating cardiac injuries: our 10-year results. Turk Gogus Kalp Dama 2011;19:337-43.
  • 2. Kang, N, Hsee L, Rizoli S, Alison P. Penetrating cardiac injury: overcoming the limits set by Nature. Injury 2009;40:919-27.
  • 3. Asensio JA, Murray J, Demetriades D, Berne J, Cornwell E, Velmahos G, et al. Penetrating cardiac injuries: a prospective study of variables predicting outcomes. J Am Coll Surg 1998;186:24-34.
  • 4. Gao JM, Gao YH, Wei GB, Liu GL, Tian XY, Hu P, et al. Penetrating cardiac wounds: principles for surgical management. World J Surg 2004;28:1025-9.
  • 5. Campbell NC, Thomso SR, Muckart DJ, Meumann CM, Van Middelkoop I, Botha JB. Review of 1198 cases of penetrating cardiac trauma. Br J Surg 1997;84:1737-40.
  • 6. Buckman RF, Badellino MM, Mauro LH, Asensio JA, Caputo C, Gass J, et al. Penetrating cardiac wounds: prospective study of factors influencing initial resuscitation. J Trauma 1993;34:717-27.
  • 7. Moreno C, Moore EE, Majune JA, Hopeman AR. Pericardial tamponade. A critical determinant for survival following penetrating cardiac wounds. J Trauma 1986;26:821-5.
  • 8. Göz M, Cakir O, Eren MN. Penetrating cardiac injuries: analysis of the mortality predictors. Ulus Travma Acil Cerrahi Derg 2009;15:362-6.
  • 9. Pereira BM, Nogueira VB, Calderan TR, Villaça MP, Petrucci O, Fraga GP. Penetrating cardiac trauma: 20-y experience from a university teaching hospital. J Surg Res 2013;183:792-7.
  • 10. Rozycki GS, Feliciano DV, Ochsner MG, Knudson MM, Hoyt DB, Davis F, et al. The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma 1999;46:543-51.
  • 11. Co SJ, Yong-Hing CJ, Galea-Soler S, Ruzsics B, Schoepf UJ, Ajlan A, et al. Role of imagining in penetrating and blunt traumatic injury to the heart. Radiographics 2011;31:E101-15.
  • 12. Plurad DS, Bricker S, Van Natta TL, Neville A, Kim D, Bongard F, et al. Penetrating cardiac injury and the significance of chest computed tomography findings. Emerg Radiol 2013;20:279-84.
  • 13. Kayalar N, Boyacıoğlu K, Ketenciler S, Kuplay H, Mert B, Yücel C, et al. Emergency vascular injuries: patient profile, management strategies and risk factors for mortality. Turk Gogus Kalp Dama 2017;25:74-81.
  • 14. Thorson CM, Namias N, Van Haren RM, Guarch GA, Ginzburg E, Salerno TA, et al. Does hemopericardium after chest trauma mandate sternotomy? J Trauma Acute Care Surg 2012;72:1518-24.
  • 15. Nicol AJ, Navsaria PH, Hommes M, Ball CG, Edu S, Kahn D. Sternotomy or drainage for a hemopericardium after penetrating trauma: a randomized controlled trial. Ann Surg 2014 ;259:438-42.
  • 16. Molina EJ, Gaughan JP, Kulp H, McClurken JB, Goldberg AJ, Seamon MJ. Outcomes after emergency department thoracotomy for penetrating cardiac injuries: a new perspective. Interact Cardiovasc Thorac Surg 2008;7:845-8.
  • 17. Mataraci I, Polat A, Cevirme D, Büyükbayrak F, Saşmazel A, Tuncer E, et al. Increasing numbers of penetrating cardiac trauma in a new center. Ulus Travma Acil Cerrahi Derg 2010;16:54-8.
  • 18. Tang AL, Inaba K, Branco BC, Oliver M, Bukur M, Salim A, et al. Postdischarge complications after penetrating cardiac injury: a survivable injury with a high postdischarge complication rate. Arch Surg 2011;146:1061-6.

Kardiyak Travma Hastalarında Cerrahi Tedavi

Yıl 2018, Cilt: 21 Sayı: 2, 111 - 116, 19.08.2018

Öz

Giriş: Penetran travmalar; ateşli silah yaralanması ve kesici alet dahil, kardiyak
yaralanmaların esas sebeplerindendir. Bu çalışmanın amacı, kalp travması
hastalarının tanı ve cerrahi tedavisini değerlendirmektir.



Hastalar ve
Yöntem:
Kliniğimizde Şubat 2009-Mayıs 2017 tarihleri arasında
penetran kardiyak yaralanma nedeniyle opere edilen 48 hasta retrospektif olarak
incelendi. Hemodinamik olarak stabil olan hastalara ekokardiyografi,
bilgisayarlı tomografi ve laboratuvar çalışmaları yapıldı.



Bulgular: Penetran kardiyak yaralanma tanısı ile 48 hasta (45 erkek, 3 kadın;
ortalama yaş 29.4 ± 11.1 yıl; dağılım 16-51 yıl) opere edildi. Olguların 46
(%95.8)'sında etyoloji delici kesici alet yaralanmasıydı. 29 (%60.4) hastada
kardiyojenik şok mevcuttu. Kırk dört hastaya median sternotomi yapıldı. Hastaların
28 (%58.3)’inde sağ ventrikül yaralanması vardı ve burası en sık yaralanan
bölgeydi. En çok yaralanan kalp dışı organ; 15 hasta ile akciğerlerdi.
Çalışmamızda mortalite oranı 13 hasta ile %27.1 olarak tespit edildi.
Hastaların hemodinamik durumlarının, preoperative CPR gereksinimi olmasının ve
preoperative hematokrit değerlerinin 
mortalite üzerine anlamlı etkileri olduğu bulundu.



Sonuç: Penetran kardiyak
travmalarda erken tanı ve acil cerrahi girişim hayatta kalım oranlarını
arttıracaktır. Hastaların hastaneye varış anındaki hemodinamik durumları
prognoz üzerinde belirleyicidir.

Kaynakça

  • 1. Yavuz C, Çil H, Başyiğit İ, Demirtaş S, İslamoğlu Y, Tekbaş G, et al. Factors affecting mortality in penetrating cardiac injuries: our 10-year results. Turk Gogus Kalp Dama 2011;19:337-43.
  • 2. Kang, N, Hsee L, Rizoli S, Alison P. Penetrating cardiac injury: overcoming the limits set by Nature. Injury 2009;40:919-27.
  • 3. Asensio JA, Murray J, Demetriades D, Berne J, Cornwell E, Velmahos G, et al. Penetrating cardiac injuries: a prospective study of variables predicting outcomes. J Am Coll Surg 1998;186:24-34.
  • 4. Gao JM, Gao YH, Wei GB, Liu GL, Tian XY, Hu P, et al. Penetrating cardiac wounds: principles for surgical management. World J Surg 2004;28:1025-9.
  • 5. Campbell NC, Thomso SR, Muckart DJ, Meumann CM, Van Middelkoop I, Botha JB. Review of 1198 cases of penetrating cardiac trauma. Br J Surg 1997;84:1737-40.
  • 6. Buckman RF, Badellino MM, Mauro LH, Asensio JA, Caputo C, Gass J, et al. Penetrating cardiac wounds: prospective study of factors influencing initial resuscitation. J Trauma 1993;34:717-27.
  • 7. Moreno C, Moore EE, Majune JA, Hopeman AR. Pericardial tamponade. A critical determinant for survival following penetrating cardiac wounds. J Trauma 1986;26:821-5.
  • 8. Göz M, Cakir O, Eren MN. Penetrating cardiac injuries: analysis of the mortality predictors. Ulus Travma Acil Cerrahi Derg 2009;15:362-6.
  • 9. Pereira BM, Nogueira VB, Calderan TR, Villaça MP, Petrucci O, Fraga GP. Penetrating cardiac trauma: 20-y experience from a university teaching hospital. J Surg Res 2013;183:792-7.
  • 10. Rozycki GS, Feliciano DV, Ochsner MG, Knudson MM, Hoyt DB, Davis F, et al. The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma 1999;46:543-51.
  • 11. Co SJ, Yong-Hing CJ, Galea-Soler S, Ruzsics B, Schoepf UJ, Ajlan A, et al. Role of imagining in penetrating and blunt traumatic injury to the heart. Radiographics 2011;31:E101-15.
  • 12. Plurad DS, Bricker S, Van Natta TL, Neville A, Kim D, Bongard F, et al. Penetrating cardiac injury and the significance of chest computed tomography findings. Emerg Radiol 2013;20:279-84.
  • 13. Kayalar N, Boyacıoğlu K, Ketenciler S, Kuplay H, Mert B, Yücel C, et al. Emergency vascular injuries: patient profile, management strategies and risk factors for mortality. Turk Gogus Kalp Dama 2017;25:74-81.
  • 14. Thorson CM, Namias N, Van Haren RM, Guarch GA, Ginzburg E, Salerno TA, et al. Does hemopericardium after chest trauma mandate sternotomy? J Trauma Acute Care Surg 2012;72:1518-24.
  • 15. Nicol AJ, Navsaria PH, Hommes M, Ball CG, Edu S, Kahn D. Sternotomy or drainage for a hemopericardium after penetrating trauma: a randomized controlled trial. Ann Surg 2014 ;259:438-42.
  • 16. Molina EJ, Gaughan JP, Kulp H, McClurken JB, Goldberg AJ, Seamon MJ. Outcomes after emergency department thoracotomy for penetrating cardiac injuries: a new perspective. Interact Cardiovasc Thorac Surg 2008;7:845-8.
  • 17. Mataraci I, Polat A, Cevirme D, Büyükbayrak F, Saşmazel A, Tuncer E, et al. Increasing numbers of penetrating cardiac trauma in a new center. Ulus Travma Acil Cerrahi Derg 2010;16:54-8.
  • 18. Tang AL, Inaba K, Branco BC, Oliver M, Bukur M, Salim A, et al. Postdischarge complications after penetrating cardiac injury: a survivable injury with a high postdischarge complication rate. Arch Surg 2011;146:1061-6.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Orijinal Araştırmalar
Yazarlar

Kamil Boyacıoğlu Bu kişi benim

Serkan Ketenciler Bu kişi benim

Cihan Yücel Bu kişi benim

İlknur Akdemir Bu kişi benim

Nihan Kayalar Bu kişi benim

Vedat Erentuğ Bu kişi benim

Yayımlanma Tarihi 19 Ağustos 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 21 Sayı: 2

Kaynak Göster

Vancouver Boyacıoğlu K, Ketenciler S, Yücel C, Akdemir İ, Kayalar N, Erentuğ V. Surgical Management of Penetrating Cardiac Trauma Patients. Koşuyolu Heart Journal. 2018;21(2):111-6.