Skip to main content
SpringerLink
Log in
Book cover

The Shock Trauma Manual of Operative Techniques pp 173–194Cite as

Cardiac Injury

  • Chapter

  • 1972 Accesses

Abstract

Cardiac wounds are uncommon and seen mainly at urban trauma centers. Despite advancements in surgical care, prehospital treatment, and resuscitation, cardiac injury remains highly lethal. In fact, over several decades survival has not improved, underscoring their lethality. One factor that may influence the poor outcome is a mortality bias due to the rapid transit of patients with devastating, non-survivable injuries to the hospital. When considering only the patients who survive to treatment at trauma centers, the incidence of cardiac injury is quite low. The number of patients with blunt cardiac rupture who survive to treatment is even less common. It is estimated that 8–86 % of immediate deaths after significant blunt chest trauma are a result of blunt cardiac rupture. Gunshot wounds (GSWs) account for the majority of penetrating cardiac injuries (58–76 %), while stab wounds account for most of the remainder.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Asensio JA, Murray J, Demetriades D, et al. Penetrating cardiac injuries: a prospective study of variables predicting outcomes. J Am Coll Surg. 1998;186:24–34.

    Article  CAS  PubMed  Google Scholar 

  2. Tyburski JG, Astra L, Wilson RF, Dente C, Steffes C. Factors affecting prognosis with penetrating wounds of the heart. J Trauma. 2000;48:587–90. discussion 590–1.

    Article  CAS  PubMed  Google Scholar 

  3. Naughton MJ, Brissie RM, Bessey PQ, McEachern MM, Donald Jr JM, Laws HL. Demography of penetrating cardiac trauma. Ann Surg. 1989;209:676–81. discussion 682–3.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Rhee PM, Foy H, Kaufmann C, et al. Penetrating cardiac injuries: a population-based study. J Trauma. 1998;45:366–70.

    Article  CAS  PubMed  Google Scholar 

  5. Kaplan AJ, Norcross ED, Crawford FA. Predictors of mortality in penetrating cardiac injury. Am Surg. 1993;59:338–41.

    CAS  PubMed  Google Scholar 

  6. O’Connor J, Ditillo M, Scalea T. Penetrating cardiac injury. J R Army Med Corps. 2009;155:185–90.

    Article  PubMed  Google Scholar 

  7. Tang AL, Inaba K, Branco BC, et al. Postdischarge complications after penetrating cardiac injury: a survivable injury with a high postdischarge complication rate. Arch Surg. 2011;146:1061–6.

    Article  PubMed  Google Scholar 

  8. Asensio JA, Garcia-Nunez LM, Petrone P. Trauma to the heart. In: Feliciano DV, Mattox KL, Moore EE, editors. Trauma. 6th ed. New York, NY: McGraw-Hill Medical; 2008. p. 569–86.

    Google Scholar 

  9. Teixeira PG, Inaba K, Oncel D, et al. Blunt cardiac rupture: a 5-year NTDB analysis. J Trauma. 2009;67:788–91.

    Article  PubMed  Google Scholar 

  10. Asensio JA, Berne JD, Demetriades D, et al. One hundred five penetrating cardiac injuries: a 2-year prospective evaluation. J Trauma. 1998;44:1073–82.

    Article  CAS  PubMed  Google Scholar 

  11. Beck C. Wounds of the heart. Arch Surg. 1926;13:205–27.

    Article  Google Scholar 

  12. Homer. The Iliad. New York, NY: Farrar, Straus and Giroux; 2004.

    Google Scholar 

  13. Hippocrates. The genuine works of Hippocrates. New York, NY: William Wood and Co; 1886. p. 252. Vol 2, sec 6, aphorism 18.

    Google Scholar 

  14. Juan A, Patrizio P, Bruno P, Diego P, Supparerk P, Taichiro T, Francisco R, Antonio M, Alan C, Eduardo DM. Penetrating cardiac injuries: a historic perspective and fascinating trip through time. J Am Coll Surg. 2009;208:462–72.

    Article  Google Scholar 

  15. Aristotle (384–322 BC). The Partibus Animalium. Lib III, chap 4. Opera Edidit Academia Regia Borrusca, vol 3, 328. As quoted by Beck CS. Wounds of the Heart. Arch Surg 1926;13:205–27.

    Google Scholar 

  16. Galen (130–200AD). Medicorum Graecorum Opera. Vol VIII, Lipsiae Prostat in officina Libraria Car. Cuoblochii 1824, Le Locis Affectis. Edited by Kuhn DC: Tome VIII, lib V, chap 2, 304. As quoted by Beck CS. Wounds of the Heart. Arch Surg 1926;13:205–27

    Google Scholar 

  17. Hollerius J. Communis aphorismi allegati. Quoted from Fisher G: Die Wuden des Herzeus und des Herzbeutels. Arch Klin Chir 1868;9;571. As quoted by Beck CS. Wounds of the heart. Arch Surg. 1926;13:205–27.

    Article  Google Scholar 

  18. Wolf I. Cited by Fischer G. D Die Wunden des Herzeus und des Herzbeutels. Arch Klin Chir. 1868;9:571.

    Google Scholar 

  19. Saplacan V, Cuttone F, Massetti M. The ignored birth of cardiac surgery: the history of the surgical treatment of heart wounds and pericardial effusions. In: Piciche M, editor. Dawn and evolution of cardiac procedures: research avenues in cardiac surgery and interventional cardiology. Italy: Springer; 2013. p. 24.

    Google Scholar 

  20. Asensio JA, Soto SN, Forno W, et al. Penetrating cardiac injuries: a complex challenge. Injury. 2001;32:533–43.

    Article  CAS  PubMed  Google Scholar 

  21. Westaby S, Bosher C. Landmarks in cardiac surgery. Oxford: Isis Medical Media Ltd.; 1997.

    Google Scholar 

  22. Mandal AKS, Sanusi M. Penetrating chest wounds: 24 years experience. World J Surg. 2001;25:1145–9.

    Article  CAS  PubMed  Google Scholar 

  23. Asensio JA, Stewart BM, Murray J, et al. Penetrating cardiac injuries. Surg Clin North Am. 1996;76:685–724.

    Article  CAS  PubMed  Google Scholar 

  24. Elias D, Peter L, Dietrich D, Fabrizio B, Douglas B, Martin S. Penetrating cardiac injuries: recent experience in South Africa. World J Surg. 2006;30:1258–64.

    Article  Google Scholar 

  25. Claassen CW, O’connor JV, Gens D, Sikorski R, Scalea TM. Penetrating cardiac injury: think outside the box. J Trauma. 2010;68:E71–3.

    Article  PubMed  Google Scholar 

  26. Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N. Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg. 2000;190:288–98.

    Article  CAS  PubMed  Google Scholar 

  27. Ernest M, Knudson MM, Clay B, Kenji I, Rochelle D, Walter B, Ajai M, Martin S, Timothy B, Raul C, Ernest G, Meredith JW, David L, Krista K. Defining the limits of resuscitative emergency department thoracotomy: a contemporary Western Trauma Association perspective. J Trauma. 2011;70:334–9.

    Article  Google Scholar 

  28. Burlew CC. Resuscitative thoracotomy. Available at: http://westerntrauma.org/algorithms/WTAAlgorithms_files/gif_8.htm. Accessed October 28, 2013.

  29. Rozycki GS, Ballard RB, Feliciano DV, Schmidt JA, Pennington SD. Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg. 1998;228:557–67.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Rozycki GS, Feliciano DV, Ochsner MG, Knudson MM, Hoyt DB, Davis F, Hammerman D, Figueredo V, Harviel JD, Han DC, Schmidt JA. The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma. 1999;46:543–51.

    Article  CAS  PubMed  Google Scholar 

  31. Vivek T, Michael B, John M, Christian T, Michael T. FAST (focused assessment with sonography in trauma) accurate for cardiac and intraperitoneal injury in penetrating anterior chest trauma. J Ultrasound Med. 2004;23:467–72.

    Google Scholar 

  32. Chad B, Brian W, Amy W, Jeffrey N, Grace R, David F. A caveat to the performance of pericardial ultrasound in patients with penetrating cardiac wounds. J Trauma. 2009;67:1123–4.

    Article  Google Scholar 

  33. Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, Hameed SM, Brown R, Simons R, Dulchavsky SA, Hamiilton DR, Nicolaou S. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with sonography for trauma (EFAST). J Trauma. 2004;57:288–95.

    Article  CAS  PubMed  Google Scholar 

  34. Olga B, Nira B-R, Subhi A, Janna F, Anat I, Diana L, Diana G. Sonographic detection of pneumothorax by radiology residents as part of extended focused assessment with sonography for trauma. J Ultrasound Med. 2009;28:749–55.

    Google Scholar 

  35. Moore EE, Cogbill TH, Malangoni M, Jurkovich GJ, Champion HR. Scaling system for organ specific injuries. Available at: http://www.aast.org/Library/TraumaTools/InjuryScoringScales.aspx. Accessed October 28, 2013.

  36. Henry SM, Duncan AO, Scalea TM. Intestinal Allis clamps as temporary vascular control for major retroperitoneal venous injury. J Trauma. 2001;51:170–2.

    Article  CAS  PubMed  Google Scholar 

  37. Kokotsakis J, Hountis P, Antonopoulos N, Skouteli E, Athanasiou T, Lioulias A. Intravenous adenosine for surgical management of penetrating heart wounds. Tex Heart Inst J. 2007;34:80–1.

    PubMed Central  PubMed  Google Scholar 

  38. Cha EK, Mittal V, Allaben RD. Delayed sequelae of penetrating cardiac injury. Arch Surg. 1993;128:836–9.

    Article  CAS  PubMed  Google Scholar 

  39. Loizos A, Petros P, Christos E, Evagoras N. A penetrating heart injury resulting in ventricular septal defect. Hellenic J Cardiol. 2011;52:71–4.

    Google Scholar 

  40. Menaker J, Tesoriero RB, Hyder M, Sikorski R, Scalea TM. Traumatic atrial septal defect and papillary muscle rupture requiring mitral valve replacement after blunt injury. J Trauma. 2009;67:1126.

    Article  PubMed  Google Scholar 

  41. Diana Y, Nir H, Wendy R, Fardad E, Paul S, Aman M. Intraoperative transesophageal echocardiography in chest trauma. J Trauma. 2008;65:924–6.

    Article  Google Scholar 

  42. Nan Yu-Yun L, Ming-Shian LK-S, Yao-Kuang H, Feng-Chun T, Jaw-Ji C, Pyng L. Blunt traumatic cardiac rupture: therapeutic options and outcomes. Injury. 2009;40:938–45.

    Article  CAS  PubMed  Google Scholar 

  43. Cothren CC, Moore EE. Emergency department thoracotomy for the critically injured patient: objectives, indications, and outcomes. World J Emerg Surg. 2006;1:4.

    Article  PubMed Central  PubMed  Google Scholar 

  44. May AK, Patterson MA, Rue 3rd LW, Schiller HJ, Rotondo MF, Schwab CW. Combined blunt cardiac and pericardial rupture: review of the literature and report of a new diagnostic algorithm. Am Surg. 1999;65:568–74.

    CAS  PubMed  Google Scholar 

  45. Gilman K, Ipaktchi K, Moore EE, Barnett C, Gurunluoglu R. Reconstruction of an emergency thoracotomy wound with free rectus abdominis flap: anatomic and radiologic basis for the surgical technique. World J Emerg Surg. 2010;5:12.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA

    Ron Tesoriero M.D., F.A.C.S.

Authors
  1. Ron Tesoriero M.D., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA

    Thomas M. Scalea

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Tesoriero, R. (2015). Cardiac Injury. In: Scalea, T. (eds) The Shock Trauma Manual of Operative Techniques. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2371-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2371-7_10

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2370-0

  • Online ISBN: 978-1-4939-2371-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation