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Outcomes of Cardiac Gunshot Injuries Presenting at an Urban Trauma Facility in Johannesburg, South Africa

  • Surgery in Low and Middle Income Countries
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Gunshot wounds to the heart are regarded as one of the most lethal penetrating injuries. There has been an increase in gunshot wounds to the chest in our institution in recent years. Injuries to the heart caused by gunshot wounds can be challenging, with patients arriving in hospital in different physiological states. We report our trauma unit’s experience with civilian gunshot wounds to the heart.


A retrospective review from January 2005 till December 2018 of those 18 years of age and above who presented to our hospital with penetrating cardiac injuries over eight years was done. Those who presented with a carotid pulse and a cardiac rhythm were included in the study. Blood pressure of less than 90 mmHg was considered as haemodynamic instability. Demographics, physiological parameters, injuries sustained, preferred surgical access to the chest, and type of surgery were analysed. The complications during their hospital stay and outpatient clinic were documented. The incidences of in-hospital mortality were also noted. Descriptive statistics with STATA version 15 were conducted. A p-value of < 0.05 was considered statistically significant.


A total of 37 patients were enroled in the study; four were excluded for incomplete data. All presented directly from the scene, with a median age of 30 (IQR 24–36). Haemodynamic instability was in 64% of the cases. The most common injured chamber was the right ventricle (75.7%). There were only two complications recorded; local wound sepsis and empyema. All survivors received a post-surgical echocardiogram. The overall survival rate was 18.9% (n = 7). Of the ten that required emergency room thoracotomy, only one survived to discharge.


Gunshot wounds to the heart have a mortality rate greater than 80% in those arriving alive. Only one in ten of those who meet the strict criteria for emergency room thoracotomy survive hospitalisation. The local complication rate was low.

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  1. Lone RA, Wani MA, Hussain Z et al (2009) Missile cardiac injuries: review of 16 years’ experience. Ulus Travma ve Acil Cerrahi Derg 15(4):353–356

    Google Scholar 

  2. Asfaw I, Arbulu A (1977) Penetrating wounds of the pericardium and heart. Surg Clin N Am 57(1):37–48

    Article  CAS  PubMed  Google Scholar 

  3. Campbell NC, Thomson SR, Muckart DJJ et al (1997) Review of 1198 cases of penetrating cardiac trauma. Br J Surg 84(12):1737–1740

    CAS  PubMed  Google Scholar 

  4. Mandal AK, Sanusi M (2001) Penetrating chest wounds: 24 years’ experience. World J Surg 25(9):563–568

    Article  Google Scholar 

  5. Buckman RF, Badellino MM, Mauro LH et al (1993) Penetrating cardiac wounds: prospective study of factors influencing initial resuscitation. J Trauma Injury Infect Crit Care 34(5):717–725

    Article  Google Scholar 

  6. Asensio JA, Berne JD, Demetriades D et al (1998) One hundred five penetrating cardiac injuries. J Trauma 44(6):1073–1082

    Article  CAS  PubMed  Google Scholar 

  7. Luna G, Adye B, Haun-Hood M et al (2001) Intentional injury treated in community hospitals. Am J Surg 181(5):463–465

    Article  CAS  PubMed  Google Scholar 

  8. Inkinen J, Kirjasuo K, Gunn J, Kuttila K (2015) Penetrating trauma; experience from Southwest Finland between 1997 and 2011, a retrospective descriptive study. Eur J Trauma Emerg Surg 41(4):429–433

    Article  CAS  PubMed  Google Scholar 

  9. Madiba TE, Thomson SR, Mdlalose N (2001) Penetrating chest injuries in the firearm era. Injury 32(1):13–16

    Article  CAS  PubMed  Google Scholar 

  10. Degiannis E, Loogna P, Doll D et al (2006) Penetrating cardiac injuries: recent experience in South Africa. World J Surg 30(7):1258–1264

    Article  PubMed  Google Scholar 

  11. van Waes OJF, Halm JA, van Imhoff DI et al (2018) Selective nonoperative management of penetrating thoracic injury. Eur J Emerg Med 25(1):32–38

    Article  PubMed  Google Scholar 

  12. Clarke DL, Quazi MA, Reddy K, Thomson SR (2011) Emergency operation for penetrating thoracic trauma in a metropolitan surgical service in South Africa. J Thorac Cardiovasc Surg 142(3):563–568

    Article  PubMed  Google Scholar 

  13. Rhee PM, Moore EE, Joseph B et al (2016) Gunshot wounds: a review of ballistics, bullets, weapons, and myths. J Trauma Acute Care Surg 80(6):853–867

    Article  PubMed  Google Scholar 

  14. Christoffel KK (2007) Firearm injuries: epidemic then, endemic now. Am J Public Health 97(4):626–629

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pinto A, Russo A, Reginelli A et al (2019) Gunshot wounds: ballistics and imaging findings. Semin Ultrasound CT MR 40(1):25–35

    Article  PubMed  Google Scholar 

  16. Ngwisanyi W, Moeng SFAP, Moeng M (2021) Shockwave cardiac injury in thoracoabdominal gunshot wound. Int J Surg Case Rep 80:105673.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tran HV, Charles M, Garrett RC et al (2020) Ten-year trends in traumatic cardiac injury and outcomes: a trauma registry analysis. Ann Thorac Surg 110(3):844–848

    Article  PubMed  Google Scholar 

  18. Tyburski JG, Astra L, Wilson RF et al (2000) Factors affecting prognosis with penetrating wounds of the heart. J Trauma Injury Infect Crit Care 48(4):587–590

    Article  CAS  Google Scholar 

  19. Morse BC, Mina MJ, Carr JS et al (2016) Penetrating cardiac injuries: a 36-year perspective at an urban, level I trauma center. J Trauma Acute Care Surg 81(4):623–631

    Article  PubMed  Google Scholar 

  20. Castriconi M, Festa P, Bartone G, et al (2013) Penetrating cardiac injuries. Two case reports. Ann Ital Chir 84 (ePub):S2239253X13020987

  21. Grabinsky A, Williamson K, Ramesh R (2011) Advances in prehospital trauma care. Int J Crit Illn Inj Sci 1(1):44–50

    Article  PubMed  PubMed Central  Google Scholar 

  22. Naidoo S, van As AB (2011) Vulnerability of children to gunshot trauma in violence-prone environment: the case of South Africa. Afr J Paediatr Surg 8(1):101–104

    Article  PubMed  Google Scholar 

  23. Moeng M, Boffard K (2017) Baliistics in Trauma. In: George V, Elias D, Dietrich D (eds) Penetrating trauma a practical guide on operative techniques and peri_operative management, 2nd edn. Springer Nature, Berlin Heidelberg

    Google Scholar 

  24. Monzon BI, del Ortega MC, Goosen J et al (2021) Emergency room thoracotomy (ERT): a retrospective audit of results. Albanian J Trauma Emerg Surg 5(1):745–749

    Article  Google Scholar 

  25. DuBose JJ, Morrison J, Moore L et al (2020) Does clamshell thoracotomy better facilitate thoracic life-saving procedures without increased complication compared with an anterolateral approach to resuscitative thoracotomy? Results from the American Association for the surgery of trauma aortic occlusion for resuscitation in trauma and acute care surgery registry. J Am Coll Surg 231(6):713–719

    Article  PubMed  Google Scholar 

  26. Tang AL, Inaba K, Branco BC et al (2011) Postdischarge complications after penetrating cardiac injury: a survivable injury with a high postdischarge complication rate. Arch of Surg 146(9):1061–1066.

    Article  Google Scholar 

  27. Carr JA, Buterakos R, Bowling WM et al (2011) Long-term functional and echocardiographic assessment after penetrating cardiac injury: 5-year follow-up results. J Trauma 70(3):701–704.

    Article  PubMed  Google Scholar 

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Correspondence to Maeyane S. Moeng.

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Moeng, M.S., Makhadi, S. & Molewa, M.C. Outcomes of Cardiac Gunshot Injuries Presenting at an Urban Trauma Facility in Johannesburg, South Africa. World J Surg 47, 863–869 (2023).

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