Advertisement

Penetrating Cardiac Injury

  • Antonino M. GrandeEmail author
  • Alessandro Mazzola
Chapter
First Online:

Abstract

This chapter deals primarily with all features in penetrating cardiac wounds, considered the most common cause among cardiac injuries, with the predominant cause being gunshot and stab wounds. Cardiac injuries are exceedingly devastating lesions and present a great challenge because these injuries require urgent and emergency intervention to prevent death. Sometimes serious cardiac injury may manifest only subtle or occult symptoms or signs. Particular attention is given to the topic of the cardiac box, the area where all penetrating trauma may determine an injury to the heart structures and the great vessels. A diagnostic algorithm is discussed in order to obtain an immediate right diagnosis and to transfer the patient immediately in surgery. Surgical techniques in both gunshot and stab wounds are explained and several cases are illustrated. Furthermore, we describe procedural complications in interventional cardiology, some illustrative clinical cases, and a case scenario.

Keywords

Penetrating cardiac wound Cardiac box Cardiac tamponade Hemothorax e-FAST (extended focused assessment with sonography for trauma) Iatrogenic trauma 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Campbell NC, Thomson 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.CrossRefGoogle Scholar
  2. 2.
    Kish G, Kozloff L, Joseph WL, Adkins PC. Indications for early thoracotomy in the management of chest trauma. Ann Thorac Surg. 1976;22:23–8.CrossRefGoogle Scholar
  3. 3.
    Demetriades D, van der Veen BW. Penetrating injuries of the heart: experience over two years in South Africa. J Trauma. 1983;23:1034–41.CrossRefGoogle Scholar
  4. 4.
    Asensio JA, Soto SN, Forno W, Roldan G, Petrone P, Salim A, et al. Penetrating cardiac injuries: a complex challenge. Injury. 2001;32:533–43.CrossRefGoogle Scholar
  5. 5.
    Asensio JA, Berne JD, Demetriades D, Chan L, Murray J, Falabella A, et al. One hundred five penetrating cardiac injuries: a 2-year prospective evaluation. J Trauma. 1998;44:1073–82.CrossRefGoogle Scholar
  6. 6.
    Thourani VH, Feliciano DV, Cooper WA, Brady KM, Adams AB, Rozycki GS, et al. Penetrating cardiac trauma at an urban trauma center: a 22-year perspective. Am Surg. 1999;65:811–6.PubMedGoogle Scholar
  7. 7.
    Degiannis E, Loogna P, Doll D, Bonanno F, Bowley DM, Smith MD. Penetrating cardiac injuries: recent experience in South Africa. World J Surg. 2006;30:1258–64.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    Asensio JA, Stewart BM, Murray J, Fox AH, Falabella A, Gomez H, et al. Penetrating cardiac injuries. Surg Clin North Am. 1996;76:685–724.CrossRefGoogle Scholar
  10. 10.
    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.CrossRefGoogle Scholar
  11. 11.
    Demetriades D, Rabinowitz B, Markides N. Indications for thoracotomy in stab injuries of the chest: a prospective study of 543 patients. Br J Surg. 1986;73:888–90.CrossRefGoogle Scholar
  12. 12.
    Restrepo CS, Gutierrez FR, Marmol-Velez JA, Ocazionez J, Martinez-Jimenez S. Imaging patients with cardiac trauma. Radiographics. 2012;32:633–49.CrossRefGoogle Scholar
  13. 13.
    Burack JH, Kandil E, Sawas A, et al. Triage and outcome of patients with mediastinal penetrating trauma. Ann Thorac Surg. 2007;83:377–82.CrossRefGoogle Scholar
  14. 14.
    Yamamoto L, Schroeder C, Morley D, Beliveau C. Thoracic trauma: the deadly dozen. Crit Care Nurs Q. 2005;28:22–40.CrossRefGoogle Scholar
  15. 15.
    Agarwal D, Chandra S. Challenges in the diagnosis of blunt cardiac injuries. Indian J Surg. 2009;71:245–53.CrossRefGoogle Scholar
  16. 16.
    Adams A, Fotiadis N, Chin JY, Sapsford W, Brohi K. A pictorial review of traumatic pericardial injuries. Insight Imaging. 2012;3:307–11.CrossRefGoogle Scholar
  17. 17.
    Westphal LF, Lima LC, Jaber BA. Traumatic late cardiac tamponade: analysis of five cases. J Pneumol. 2000;26:241–4.CrossRefGoogle Scholar
  18. 18.
    da Costa Medeiros BJ. Silent cardiac wound. J Cardiothorac Trauma. 2016;1:19–20.CrossRefGoogle Scholar
  19. 19.
    Divisi D, Villani C, Di Tommaso S, Mazzola A. Fortunate finger deviation of a fatal heart bullet injury. Heart Views. 2010;11:126–7.CrossRefGoogle Scholar
  20. 20.
    Grande AM, Antonacci F, Aseni P. Penetrating cardiac wounds: A case report with management algorithm and review of the literature. Emerg Care J 2018; 14:14:63–7. https://doi.org/10.481/ecj.2018.7384.
  21. 21.
    Barrou B, Billault C, Nicolas-Robin. The use of extracorporeal membranous oxygenation in donors after cardiac death. Curr Opin Organ Transplant 2013;18:148–53.CrossRefGoogle Scholar
  22. 22.
    Grande AM, Cattadori B, D’Armini AM, Viganò M. Post-traumatic pseudoaneurysm of internal mammary artery: a case report. G Chir 2006;27:377–9.Google Scholar
  23. 23.
    Grande AM, Fiore A. Merlano M, Buzzi F, Mazzola A. Aortic perforation due to cardiac resynchronization therapy defibrillator lead placement: Case report and medicolegal considerations. J Arrhythmia 2015;31:398–400.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Cardiac SurgeryIRCCS Fondazione Policlinico San MatteoPaviaItaly
  2. 2.Cardiac SurgeryIRCCS Multimedica Sesto S. GiovanniMilanoItaly

Personalised recommendations

Cite chapter

Buy options