Diagnostics and surgical tactics in the injury of the heart

The objective is to analyze own clinical observations with the purpose of optimization of diagnostics and application of the adequate medical grant to patients with wounds of heart.

Material and methods. The results of treatment of 268 patients with heart wounds operated in the clinic for the last 27 years were analyzed. The majority of patients 202 (75.4 %) had penetrating and through wounds to the heart, 66 (24.6 %) had non-penetrating injuries. The diagnosis was based on clinical symptoms, the results of electrocardiographic, echocardiographic and x-ray studies. The clinical picture depended on the nature of the wound – penetrating or non-penetrating. Videothoracoscopy helped to clarify the nature of the damage of the heart in vague diagnostic cases. In most patients, heart damage was recognized in a timely manner, a diagnostic error was committed in 18 (6.7 %) patients. In 59 (22.0 %) cases, myocardial wounds were stitched with P-shaped sutures, and in 209 (78.0 %) – with nodular sutures.

Results. 240 (89.6 %) patients were discharged in satisfactory condition, 11 (4.1%) patients were transferred to the cardiology department for the follow-up treatment, 17 patients died with penetrating or through cardiac injury. The mortality rate was 6.4 %.

Conclusion. Emergency surgery is the only effective method of treating heart injury. Long-term results of treatment were traced in 38 patients in terms of 1 year to 10 years. All patients had a clinical recovery.

1. Вагнер Е. А. Хирургия повреждений груди. М. : Медицина, 1981. [Vagner E. A. Khirurgiya povrezhdenii grudi. Moscow, Meditsina, 1981. (In Russ.)].

2. Булынин В. И., Косоногов Л. Ф., Вульф В. Н. Ранения сердца. Воронеж : ВГУ, 1989. [Bulynin V. I., Kosonogov L. F., Vul’f V. N. Raneniyas erdtsa. Voronezh, VGU, 1989. (In Russ.)].

3. Хирургия повреждений сердца при раневой политравме и шоке / П. Н. Замятин, Я. К. Голобородько, В. В. Бойко, В. В. Булага. Харьков : Консум, 2003. [Zamyatin P. N., Goloborod’ko Ya. K., Boiko V. V., Bulaga V. V. Khirurgiya povrezhdenii serdtsa pri ranevoipolitravme i shoke. Khar’kov, Konsum, 2003. (In Russ.)].

4. Абакумов М. М. Множественные и сочетанные ранения шеи, груди, живота. М. : БИНОМ, 2013. [Abakumov M. M. Mnozhestvennye i sochetannye raneniya shei, grudi, zhivota. Moscow, BINOM, 2013. (In Russ.)].

5. Диагностика и хирургическая тактика при ранениях сердца / Р. Ш. Шаймарданов, Р. Ф. Губаев, В. Н. Коробков, В. А. Филиппов // Вестн. соврем. клин. мед. 2014. Т. 7, № 2. С. 205–208. [Shaimardanov R. Sh., Gubaev R. F., Korobkov V. N., Filippov V. A. Diagnostics and surgical tactics at wounds of heart. Vestnik sovremennoi klinicheskoi meditsiny. 2014;7(2):205–208. (In Russ.)].

6. Бисенков Л. Н., Зубарев П. Н., Трофимов В. М. и др. Неотложная хирургия груди и живота : рук-во для врачей. СПб. : СпецЛит, 2015. [Bisenkov L. N., Zubarev P. N., Trofimov V. M., Shalaev S. A., Ishchenko B. I. Neotlozhnaya khirurgiya grudi i zhivota: rukovodstvodlya vrachei. SPb., SpetsLit, 2015. (In Russ.)].

7. Дэвид В. Феличано, Кеннэт Л. Маттокс, Эрнест Е. Мур. Травма. Т. 2. М. : Изд-во Панфилова; БИНОМ; Лаборатория знаний, 2013. [David V. Feliciano, Kenneth L. Mattox, Ernest E. Moore. Trauma. Vol. 2. Moscow, Izdatel’stvo Panfilova; BINOM; Laboratoriya znanii; 2013. (In Russ.)].

8. Asensio J. A., Petrone P., Costa D. et al. An evidence-based critical appraisal of emergency department thoracotomy. Evidence-Based Surgery. 2003. № 1. Р. 11.

9. Jimenez E., Martin M., Krukenkamp I. et al. Subxihoid pericardiotomy versus echocardiography : A prospective evaluation of the diagnosis of occult penetrating cardiac injuries. Sugery. 1990. № 108. Р. 676.

10. Meyer D., Jessen M., Grayburn P. et al. Use of echocardiography to detect occult cardiac injury after penetrating thoracic trauma : A prospective study // J. Trauma. 1995. № 39. Р. 902.

11. Байдан В. I., Bepбецький С. Э., Агеев С. В. Проникнi поранения серца i перiкарда // Одеський мед. журн. 2004. Т. 4, № 84. С. 17–19. [Baidan V. I., Bepbets’kii S. E., Ageev S. V. Pronikni poraneniya sertsa i perikarda. Odes’kii med. zhurnal. 2004;4(84):17–19].

12. Ермолов А. С., Абакумов М. М., Радченко Ю. А. Диагностика и лечение ранений сердца и перикарда // Хирургия. 2001. № 1. С. 18–21. [Ermolov A. S., Abakumov M. M., Radchenko Yu. A. Diagnostika i lechenie ranenii serdtsa i perikarda. Khirurgiya. 2001;1:18–21. (InRuss.)].

13. Юшкевич А. В., Берлов Г. А., Слука Б. А. и др. Структурные изменения заживающей раны сердца в зависимости от вида шовного материала // Мед. новости. 2006. № 3. С. 158–162. [Yushkevich A. V., Berlov G. A., Sluka B. A., Yushkevich V. A., Baeshko A. A., Karbovets A.V. Structural changes ofhealing heart wound in dependence of sutural material´s kind. Meditsinskie novosti. 2006;(3):158–162. (In Russ.)].

14. Абакумов М. М., Костюченко Л. Н., Радченко Ю. А. Ранения сердца. М. : БИНОМ, 2004. [Abakumov M. M., Kostyuchenko L. N., Radchenko Yu. A. Raneniya serdtsa. Moscow, BINOM, 2004. (In Russ.)].

15. Reece I. J., Davidson K. G. Emergency surgery for stab wounds heart. Ann. R. Coll. Surg. Engl. 1983. Vol. 65, № 5. Р. 304–307.

16. Тулупов А. Н. Тяжелая сочетанная травма. СПб. : Русский ювелир, 2015. [Tulupov A. N. Tyazhelaya sochetannaya travma. SPb., Russkii Yuvelir, 2015. (In Russ.)].

17. Demetriades D. Cardiac penetrating injuries : Personal experience of 45 cases. Brit. J. Surg. 1984. Vol. 71, № 9. Р. 95–97.