Cardiac Penetrating Trauma

  • Ricardo Ferrada


In cardiac trauma there are two basic scenarios:
  1. 1.
    The patient is stable. In this case the best access is median sternotomy, because:
    • It is less painful for the patient

    • The exposure for the heart and the great vessels is optimal

    The disadvantage is that this approach provides limited access to other potentially injured structures, such as the lung, subclavian vessels, aorta, and intercostal vessels.

  2. 2.
    The patient is unstable. In this case the anterolateral thoracotomy offers several advantages:
    • It is faster

    • It can be made with basic instruments

    • It allows access to several structures besides the heart


Both techniques are described in Chap. 2.

Once the chest has been opened, the surgeon may find:
  • Cardiac tamponade

  • Hemothorax if the wound on the pericardium is a big one


Cardiac trauma Cardiac repair 

Supplementary material

Video 3.1

The sac is captured with a Kelly forceps and the incision is made with a scissor, avoiding the phrenic nerve (MP4 11666 kb)

Video 3.2

Dacron prosthesis (MP4 5769 kb)

Suggested Reading

  1. Aida H, Kagaya S. Experience of surgical repair for cardiac trauma [Japanese]. Kyobu Geka. 2018;71(9):643–7.PubMedGoogle Scholar
  2. Chestovich PJ, McNicoll CF, Fraser DR, Patel PP, Kuhls DA, Clark E, et al. Selective use of pericardial window and drainage as sole treatment for hemopericardium from penetrating chest trauma. Trauma Surg Acute Care Open. 2018;30;3(1):e000187.CrossRefGoogle Scholar
  3. Einberg M, Saar S, Seljanko A, Lomp A, Lepner U, Talving P. Cardiac injuries at estonian major trauma facilities: a 23-year perspective. 2018:1457496918783726. [Epub ahead of print].CrossRefGoogle Scholar
  4. Ferrada R. Trauma Cardíaco. Manejo Operatorio. Rev Col Cirugía 2001;16:5–15.Google Scholar
  5. Šimek M, Konečný J, Hájek R, Čižmář I, Kutěj V, Lonský V. Penetrating injuries of the heart and great vessels: fifteen years of experience of the cardiac surgery service as a part of the major trauma centre [Czech]. Acta Chir Orthop Traumatol Cech. 2018;85(2):144–8.PubMedGoogle Scholar
  6. Vlček M, Jaganjac E, Niedoba M, Landor I, Neumann J. Current treatment procedures for civilian gunshot wounds. Rozhl Chir. 2018;97(12):558–62.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ricardo Ferrada
    • 1
  1. 1.Universidad Del ValleCaliColombia

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