World Journal of Surgery

, Volume 30, Issue 7, pp 1258–1264 | Cite as

Penetrating Cardiac Injuries: Recent Experience in South Africa

  • Elias DegiannisEmail author
  • Peter Loogna
  • Dietrich Doll
  • Fabrizio Bonanno
  • Douglas M. Bowley
  • Martin D. Smith



Penetrating cardiac injury is a dramatic and lethal form of trauma. The majority of patients will die before reaching medical care, but for those who arrive at hospital alive, the diagnostic acumen and rapid surgical intervention of physicians and surgeons can lead to successful outcomes.

Materials and Methods

A structured diagnostic and management approach is used in our trauma unit to deal with penetrating cardiac injury. A retrospective study of 117 patients with penetrating trauma to the heart was conducted over 32 months; the purpose of this study was to describe our protocol and review overall outcome with this type of injury. Demographic details, mechanism of injury, and mode of presentation were recorded. Mortality and morbidity data were collated and echocardiographic follow-up was performed.


There were 109 male patients, mean age 29 years (range: 15–54 years) and 8 female patients, mean age 35 years (range: 23–56 years). Most patients (96/117) had sustained stab wounds, and the associated mortality was 15.6%. Twenty-one patients had sustained gunshot wounds (GSW), with a mortality of 81%. Gunshot wounds were significantly more likely to result in death (P ≤ 0.0001). Five patients sustained multiple cardiac wounds, and three of them died. The risk of death was not different between patients sustaining single or multiple cardiac wounds (P = 0.11). Eleven patients had thoracoabdominal injury, and 3/11 (27%) died; all of those that died had sustained GSW. The risk of death was not different between patients sustaining thoracoabdominal wounds and those with isolated thoracic injury (P = 1.0). Among the 51 patients with stab wounds who presented with cardiac tamponade, the mortality was only 8%. Compared to the other patients with stab wounds, cardiac tamponade conferred a significant survival advantage (P = 0.02).


A high index of suspicion for penetrating cardiac injury and an understanding of the modes of presentation can lead to rapid diagnosis even by inexperienced junior staff. Such a structured approach to patients with penetrating trauma to the chest leads to early definitive management and acceptable results.


Cardiac Tamponade Gunshot Wound Cardiac Injury Stab Wound Trauma Unit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by a grant from the German Ministry of Defence.


  1. 1.
    Campbell NC, Thomson SR, Muckart DJ, et al. Review of 1198 cases of penetrating cardiac trauma. Br J Surg 1997;84:1737–1740PubMedCrossRefGoogle Scholar
  2. 2.
    Velmahos GC, Degiannis E, Souter I, et al. Penetrating trauma to the heart: a relatively innocent injury. Surgery 1994;115:694–697PubMedGoogle Scholar
  3. 3.
    Krug EG, Mercy JA, Dahlberg LL, et al. The world report on violence and health. Lancet 2002;360:1083–1088PubMedCrossRefGoogle Scholar
  4. 4.
    Saadia R, Levy RD, Degiannis E, et al. Penetrating cardiac injuries: clinical classification and management strategy. Br J Surg 1994;81:1572–1575PubMedGoogle Scholar
  5. 5.
    Velmahos GC, Degiannis E, Souter I, et al. Outcome of a strict policy on emergency department thoracotomies. Arch Surg 1995;130:774–747PubMedGoogle Scholar
  6. 6.
    Rhee PM, Acosta J, Bridgeman A, et al. Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg 2000;190:288–298PubMedCrossRefGoogle Scholar
  7. 7.
    Hanpeter DE, Demetriades D, Asensio JA, et al. Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds. J Trauma 2000;49:689–694PubMedGoogle Scholar
  8. 8.
    Porter JM, Ivatury RR. Unwillingness to lie supine? a sign of pericardial tamponade. Am Surg 1997;63:365–366PubMedGoogle Scholar
  9. 9.
    Rozycki GS, Feliciano DV, Ochsner MG, et al. The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma 1999;46:543–551PubMedGoogle Scholar
  10. 10.
    Rozycki GS, Ballard RB, Feliciano DV, et al. Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg 1998;228:557–567PubMedCrossRefGoogle Scholar
  11. 11.
    Harris DG, Papagiannopoulos KA, Pretorius J, et al. Current evaluation of cardiac stab wounds. Ann Thorac Surg 1999;68:2119–2122PubMedCrossRefGoogle Scholar
  12. 12.
    Degiannis E, Bowley DM, Westaby S. Managment of penetrating cardiac injury. Ann R Coll Surg Engl 2005Google Scholar
  13. 13.
    Macho JR, Markison RE, Schecter WP. Cardiac stapling in the management of penetrating injuries of the heart: rapid control of hemorrhage and decreased risk of personal contamination. J Trauma 1993;34:711–715PubMedGoogle Scholar
  14. 14.
    Mayrose J, Jehle DV, Moscati R, et al. Comparison of staples versus sutures in the repair of penetrating cardiac wounds. J Trauma 1999;46:441–443PubMedGoogle Scholar
  15. 15.
    Bowley DM, Cherry R, Snyman T, et al. Seroprevalence of the human immunodeficiency virus in major trauma patients in Johannesburg. S Afr Med J 2002;92:792–793PubMedGoogle Scholar
  16. 16.
    Wall MJ Jr, Mattox KL, Chen CD, et al. Acute management of complex cardiac injuries. J Trauma 1997;42:905–912PubMedGoogle Scholar
  17. 17.
    Baker JM, Battistella FD, Kraut E, et al. Use of cardiopulmonary bypass to salvage patients with multiple-chamber heart wounds. Arch Surg 1998;133:855–860PubMedCrossRefGoogle Scholar
  18. 18.
    Moreno C, Moore EE, Majure JA, et al. Pericardial tamponade: a critical determinant for survival following penetrating cardiac wounds. J Trauma 1986;26:821–825PubMedGoogle Scholar
  19. 19.
    Asensio JA, Murray J, Demetriades D, et al. Penetrating cardiac injuries: a prospective study of variables predicting outcomes. J Am Coll Surg 1998;186:24–34PubMedCrossRefGoogle Scholar
  20. 20.
    Gao J, Gao YH, Wei GB. Penetrating cardiac wounds: principles for surgical management. World J Surg 2004;28:1025–1029PubMedCrossRefGoogle Scholar
  21. 21.
    Mitchell ME, Muakkassa FF, Poole GV, et al. Surgical approach of choice for penetrating cardiac wounds. J Trauma 1993;34:17–20PubMedGoogle Scholar
  22. 22.
    Asensio JA, Arroyo H Jr, Veloz W. Penetrating thoracoabdominal injuries: ongoing dilemma-which cavity and when? World J Surg 2002;26:539–543PubMedCrossRefGoogle Scholar
  23. 23.
    Hirshberg A, Wall MJ Jr, Allen MK, et al. Double jeopardy: thoracoabdominal injuries requiring surgical intervention in both chest and abdomen. J Trauma 1995;39:225–229PubMedGoogle Scholar
  24. 24.
    Demetriades D, Charalambides D, Sareli P, et al. Late sequelae of penetrating cardiac injuries. Br J Surg 1990;77:813–814PubMedGoogle Scholar
  25. 25.
    Asensio JA, Murray J, Demetriades D, et al. Penetrating cardiac injuries. Surg Clin North Am 1996;76:685–724PubMedCrossRefGoogle Scholar
  26. 26.
    Kulshrestha P, Das B, Iyer KS, et al. Cardiac injuries—a clinical and autopsy profile. J Trauma 1990;30:203–207PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Elias Degiannis
    • 1
    • 2
    Email author
  • Peter Loogna
    • 1
  • Dietrich Doll
    • 1
  • Fabrizio Bonanno
    • 1
  • Douglas M. Bowley
    • 1
  • Martin D. Smith
    • 1
  1. 1.Department of SurgeryChris Hani Baragwanath Hospital, University of WitwatersrandJohannesburgSouth Africa
  2. 2.Department of SurgeryMedical SchoolParktownSouth Africa

Personalised recommendations