Heart Injuries - Still a Challenge for Cardiac Surgery

ABSTRACT

Background: Heart injuries can be penetrating or non-penetrating (blunt). Penetrating injuries are most often caused by stab wounds made by stabbing weapons or tools as well as firearms. It is usually the right ventricle that is injured, since it is located most frontally and closest to the chest wall. Mortality in stab wounds is 20-30%, and as high as 30-60% in all penetrating wounds.

Non-penetrating injuries most often occur during traffic accidents. High pressure on the front side of the thorax towards spine, followed by sudden increase of intracardiac pressure, may lead to rupture of the free wall of the heart, intraventricular septum or valvular insufficiency, caused by ruptured leaflets, chords or papillary muscles.

Methods: Clinical outcome of 17 consecutive patients with heart injuries, treated surgically and nonsurgically, were retrospectively analyzed.

Results: Over the period from 1982 to 2007, 17 patients with heart injuries were treated at The Institute for Cardiovascular Diseases, Clinical Center of Serbia (Belgrade, Serbia). There were 14 penetrating injuries (4 inflicted by firearms, 10 by stabbing weapons).

Fifteen patients were treated surgically, and two were not operated. Within the operated group, 1 patient died postoperatively.

Conclusion: Prompt and accurate diagnosis of heart injury, fast transport and urgent surgical intervention are important factors in reducing death rate in these higly lethal condition.