Management of penetrating cardiac injuries in the Department of surgery, Mohamed Thahar Maamouri Hospital, Tunisia: report of 19 cases

Abstract

The goal of this paper is to discuss how to ameliorate the management of penetrating cardiac injuries in general surgery department. An algorithm for the initial assessment of penetrating injuries in cardiac box, based on our own experience, is presented. This was a retrospective study of 19 patients undergoing thoracotomy for penetrating cardiac injuries, managed in the department of general surgery of Nabeul-Tunisia, between 1994 and 2010. The mean age of patients was 25 years old. Sex ratio was 8,5. All patients had cardiac injury resulting from stab wounds inside of the pericardium. 42% of them were critically unstable, 21% had cardiac tamponnade. All these patients were quickly transferred to the operating room without any other investigations. 37% of patients were hemodynamically stable and underwent additional investigations. 18 patients were operated in emergency condition the same day as the traumatism. The left antero-lateral thoracotomy was the way of choice. The left ventricle was injured in 2 cases, the right ventricle in 14 cases, and the right auricle in one case. There was a contusion without myocardial lesion in 2 cases. The surgical repair consisted in a temporary digital homeostasis and a suture of the cardiac wounds. One patient died. 5 patients had a functional symptomatology. 5 patients kept electric after-effects. The management of penetrating cardiac injuries is possible in a general surgery department, but it requires a rapid prehospital transfer, a yet thorough physical examination along with efficient surgical management, all done in minimal time.

Keywords

• cardiac injury
• stab wounds
• tamponnade
• hemorrhage
• cardiac repair
• tunisia