[Traumatic cardiac injury].

Traumatic cardiac injuries are classified into sharp and blunt injuries and show various pathologic conditions. For patients' survival, each pathologic condition should be rapidly evaluated and appropriately treated. In many patients, direct suturing of the wound without using extracorporeal circulation is possible. However, in patients with intra-cardiac injury or severe free-wall injury, or patients in whom the operative field is difficult to obtain, repair under extracorporeal circulation is necessary. In our patients with sharp injury, the survival rate after surgery was 100%. However, surgical results in patients with blunt injury were markedly affected by the presence or absence of complication injuries, particularly head injury, and the survival rate after surgery was 72.7%. The survival rate may be improved by: (1) rapid and appropriate evaluation of cardiac injury in patients with multiple injuries, (2) prompt surgical treatment, and (3) comprehensive postoperative management and treatment for complication injuries.

Plasma carnitine concentrations in patients undergoing open heart surgery.

Carnitine is an essential cofactor for fatty acid (FA) metabolism, the predominant source of ATP in the normal aerobic heart. During myocardial ischemia, FA metabolism is impaired and tissue carnitine levels are depleted. Since the heart cannot synthesize carnitine, plasma carnitine could play an important role in maintaining myocardial carnitine levels during reperfusion. The purpose of this study was to determine the incidence of abnormal plasma carnitine concentrations in open heart surgery. Blood samples were obtained from eleven patients before, immediately after, and two hours after cardiopulmonary bypass (CPB). Total and free carnitine levels were significantly reduced immediately after CPB (p<0.01) and remained depressed until two hours after CPB (p<0.01 vs. pre CPB), while acyl carnitine levels were unchanged over the course of this study. These depressed free carnitine levels might affect cardiac metabolism in the heart after open heart surgery. Carnitine supplement might be a useful adjunct in the therapy after open heart surgery.

New surgical technique of left ventricular free wall rupture: double patch sealing method.

We experienced two cases of left ventricular free wall rupture (LVFWR) following acute myocardial infarction (AMI). Case 1, with the blowout type of LVFWR was initially closed by direct suture, followed by hemostasis using a double patch sealing method (DPS) by which the tear was doubly sealed with large and small bovine pericardium patches to which GRF glue was applied. Case 2 with the oozing type of LVFWR was treated only using DPS. Complete hemostasis was achieved in both cases, and aneurysmal dilatation or constrictive heart failure were not detected by postoperative left ventriculography. Therefore, DPS may be useful for treating LVFWR following AMI.