Blunt cardiac injury:experience in 43 cases treated operatively / 中华胸心血管外科杂志

ABSTRACT

Objective To explore early diagnosis， surgical intervention and efficacy for blunt cardiac injury. Methods 43 patients with blunt cardiac injury treated operatively were studied retrospectively in respect of sex, age, cause of injury, pre-operative diagnosis, operative time from injury, surgical procedures, and therapeutic efficacy. The study lasted for 15 years be-tween September 2003 and August 2018. The main cause of injury is road traffic accident with a rate of 48. 8％(21/43);and steering wheel injury accounted for 71. 4％(15/21). Preoperative diagnosis was based on computer scaning, echocardiography in 26 cases. In remaining 17, initial judgement of cardiac wound was done because of obvious cardiac tamponade, or massive hemothorax with shock;and was proved during emergent thoracotomy. Surgical intervention was started within one hour in cases of 27. 9％(12/43). Main procedures included pericardial decompression, clear off hemopericardium, and cardiorrhaphy in 36 cases;relief of pericardial herniation with strangulation of the heart in 3 cases, and repair of diaphragmatic hernia involving pericardium in 4 cases. Of all 43 cases, 7 cases underwent Emergent Department Thoracotomy( EDT) with a resuscitative rate of 42. 9％(3/7). Results Overall mortality rate was 32. 6％(14/43);4 cases died at EDT, 5 cases intraoperatively, and 5 cases postoperatively. The cause of deaths was directly related to BCI in 9 cases( associated with transected aorta in 1 case);and associated injuries in 5 cases including liver trauma ( 3 cases ) , brain trauma ( 1 case ) , and cervical spinal trauma ( 1 case) . In 4 of 29 survivors, intracardiac injury was proved by echocardiography postoperatively, including mitral valve in 2 ca-ses, tricuspid in 1 case, and ventricular septum in 1 case. Of these 4 cases 2 received valvuloplasty 2 weeks and 3 months after initial operation respectively;and other 2 restored spontaneously which were ensured by echocardiography. Postoperative com-plications included atelectasis in 3 and infectious endocarditis in 1 respectively. They were cured . All survivors were followed up from 6 to 36 months, with a normal cardiac function and healthy condition. Conclusion Early diagnosis and emergent tho-racotomy in time are essential to improve survival rate. Preoperative massive transfusion and pericardiocentesis are not advoca-ted. If it is necessary, EDT should be exercised decidedly.