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Heart and Great Vessel Injuries

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Clinical Review of Vascular Trauma

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Abstract

Blunt trauma to the heart and great vessels is often secondary to a high-energy impact to the thorax, leading to major injuries that can be rapidly fatal in many circumstances. Those patients who arrive to the emergency room with signs of life are candidates for an immediate thoracotomy. Patients who are stable may be candidates for diagnostic imaging, including ultrasonography, computed tomography, and invasive arteriography. The initial management of all patients should follow ATLS guidelines. Following the decision to proceed to surgery, an appropriate incision that maximizes access to key structures should be chosen. Full-thickness sutures for atrial lesions will avoid tearing of this thin tissue. Pledgeted sutures may be necessary for partial-thickness sutures in the ventricles. Injury to the great vessels requires proximal (i.e., hilar clamping) and distal control, and extracorporeal membrane oxygenation (ECMO) may be required in select patients following surgical correction of bleeding. Early involvement of cardiothoracic surgeons is often beneficial to help optimize overall care.

Jesper B. Ravn, MD and Justin L. Regner, MD contributed equally as senior authors.

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Author information

Authors and Affiliations

  1. Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Martin A. S. Meyer BSc

  2. Department of Surgery, Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX, USA

    Martin A. S. Meyer BSc

  3. Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Jesper B. Ravn MD

  4. Trauma, Critical Care and Acute Care Surgery, Scott and White Memorial Hospital, Texas A&M University, Temple, TX, USA

    Justin L. Regner MD

Authors
  1. Martin A. S. Meyer BSc
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  2. Jesper B. Ravn MD
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  3. Justin L. Regner MD
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Corresponding author

Correspondence to Justin L. Regner MD .

Editor information

Editors and Affiliations

  1. Department of Surgery MSB 5.030, Center for Translational Injury Research, Houston, Texas, USA

    Anahita Dua

  2. Department of Surgery, University of Texas-Houston Duke University School of Medicine, Houston, Texas, USA

    Sapan S. Desai

  3. Department of Surgery, University of Texas-Houston, Houston, Texas, USA

    John B. Holcomb

  4. Department of Orthopedics, University of Texas-Houston, Houston, Texas, USA

    Andrew R. Burgess

  5. Department of Surgery, John Hopkins Medical Institutions, Baltimore, Maryland, USA

    Julie Ann Freischlag

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© 2014 Springer-Verlag Berlin Heidelberg

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Meyer, M.A.S., Ravn, J.B., Regner, J.L. (2014). Heart and Great Vessel Injuries. In: Dua, A., Desai, S., Holcomb, J., Burgess, A., Freischlag, J. (eds) Clinical Review of Vascular Trauma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39100-2_12

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  • DOI: https://doi.org/10.1007/978-3-642-39100-2_12

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-39099-9

  • Online ISBN: 978-3-642-39100-2

  • eBook Packages: MedicineMedicine (R0)

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