Surgical Management of Penetrating Cardiac Trauma Patients

Year 2018, Volume: 21 Issue: 2, 111 - 116, 19.08.2018

Kamil Boyacıoğlu Serkan Ketenciler Cihan Yücel İlknur Akdemir Nihan Kayalar Vedat Erentuğ

Abstract

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.

Keywords

Heart injuries, emergency treatment, penetrting wounds, surgery

Kardiyak Travma Hastalarında Cerrahi Tedavi

Abstract

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.

Keywords

Kalp yaralanmaları, acil tedaviler, penetran yaralanmalar, cerrahi

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