Penetrating Heart Injury Repaired with Peripheral Cannulation: Case Report

Heart injuries usually occur due to penetrating or blunt traumas. High mortality rates are seen in heart injuries, owing to firearms and cutting/piercing tools. Factors such as the degree of injury, its localization, and the length of time to reach the hospital influence mortality rates. Despite the increase in imaging facilities and improvements in hospital transportation in today’s conditions, high mortality rates are still observed, owing to causes such as sudden blood loss, cardiac arrest, or cardiac tamponade. The present study aimed to present the successful treatment of a 46-year-old male patient with injuries to the left atrium and posterior wall of the left ventricle due to a gunshot wound using the approach of median sternotomy and peripheral cannulation.

On the issue of traumatic heart damage without perforation of the heart shirt

According to the anatomical localization of traumatic heart injuries, surgeons (Napalkov, Chugaev, Fisher, Ikovitz, etc.) are divided into the following three natural groups: 1) joint damage to the heart and bursa, 2) damage to one bursa, and 3) damage to one heart with an intact heart shirt.

The Chaos of Triage: A Model for Early Exclusion of Cardiac Injury in Chest Gunshot Wound Patients

IntroductionHeart injury caused by thoracic gunshot wounds (GSW) is especially life-threatening and require prompt diagnosis and treatment. Heart injury is especially life-threatening and requires prompt diagnosis and treatment. During the pre-hospital phase and initial triage in the emergency department (ED), early recognition of a patient with heart GSW is difficult but important. The purpose of this study was to evaluate the predictability of heart injury in patients with chest GSWs. MethodsThe National Trauma Data Bank was queried for patients with chest GSW treated at all US trauma centres from July 1, 2009, to June 30, 2016. Patients with and without heart injuries (ICD-9: 861.00-03, 861.10-13) were compared and analyzed. Multivariate logistic regression was performed to evaluate independent factors of heart injury which could be obtained during the pre-hospital or triage phase only. Step-backward selection was used to establish a model for such patients. We used the receiver operating characteristic (ROC) curve to test the accuracy of this model and Youden’s J statistic to find the cutoff value of sensitivity/specificity. Level 1 trauma registry data from Stroger Hospital of Cook County (July 1, 2016, to June 30, 2017) was used for external validation of this prediction model.Results47,044 patients with chest GSW were evaluated in the ED and 8.6% of them had heart injuries. The mortality rates of patients without cardiac injury versus those with cardiac injury were 9.0% (3864/42997) and 21.7% (879/4047) respectively. Patients with heart injuries were significantly younger (28.4 vs. 29.3, p<0.001), had lower SBP (34.7 vs. 103.8 mmHg, p<0.001), had lower GCS (5.1 vs. 11.2, p<0.001) and a higher probability of apnea (58.3% vs. 14.7%, p<0.001), higher rate of pulselessness (59.9% vs. 12.0%, p<0.001), and more self-inflicted injuries (9.7% vs. 8.5%, p<0.001) than patients without heart injuries. The cutoff values of SBP and GCS for prediction of heart injury were 61mmHg (AUC: 0.783) and 5.5 (AUC: 0.768) respectively. Integration of six independent factors (age, SBP, GCS, apnea, lack of pulse and suicide intent) with multivariate logistic regression showed an AUC: 0.823 and specificity of 88.8% in the heart injury prediction model. External validation with the local database showed 95.6% specificity.ConclusionEarly diagnosis of heart injury is important in the management of patients with chest GSWs. Our model has high specificity and can be beneficial for early triage of cardiac injury in patients with GSW to the chest.

DIAGNOSIS AND TREATMENT OF COMBAT INJURIES OF THE HEART AND GREAT VESSELS. Review

Relevance. According to the modern realities of hostilities in the East of Ukraine, the medical community has grown a request for information about the nature of the most dangerous defeats of the participants of the Joint Forces Operation (JFO) in Donbass. Objective: analysis and generalization of the nature of heart injuries received during the hostilities in the East of Ukraine, the stages of medical support of such wounded. Materials and methods. Analysis of scientific publications in scientific journals of Ukraine by keywords for the period 2014-2018. Results. The nature of injuries among participants in the JFO has been analyzed. The first place is occupied by injuries of blood vessels with bleeding (60%), 2 - pneumothorax (34%), and 3 - airway obstruction (6%). All this can be combined and supplemented by damage to the nervous system and other organs. In the conditions of the modern war in Donbass, shrapnel injuries (50.5%), bullet wounds (25.3%), and closed injury (20.3%) are considered frequent types of injuries. The classification of heart injuries, clinical symptoms, the levels of support for such a wounded are described: first aid at the prehospital stage ("golden minutes") on the battlefield, qualified medical assistance ("golden hour"), specialized medical care in a hospital. Post-traumatic stress disorders have been described that last from one to 6 months and require complex treatment. Conclusion. According to NATO's new military medical doctrine, "an effective and reliable medical support system contributes to maintaining the trust of the military and the general public in the army and its political leadership".

Heart injuries: main clinical symptoms

Injuries to the heart are uncommon in peacetime, yet they result in life-threatening conditions, which makes timely diagnostics a crucial factor in saving patients' lives. In this connection, it is important to define the main signs of heart injuries. This study aimed to analyze the basic clinical symptoms associated with various wounds to the heart. We have retrospectively analyzed such symptoms registered in 86 patients with varying chest injuries that affect the heart. All patients were treated in the emergency surgery unit of the Engels Town Hospital from 1991 to 2017. 41 (47.6%) patient had stab wounds, and there were 45 (52.3%) cases of gunshot wounds. 23 (26.7%) patients had chest injuries affecting heart exclusively, while for 63 (73.2%) the consequences were wounds to other organs. We found that the clinical picture depends on the kind of injury to the heart: stab and slash wounds translate into more pronounced symptoms, while gunshot wounds do not produce such an effect. Accepting patients, practitioners should take this fact into account. The misdiagnosis rate for stab and slash heart wounds is 9.7%, that for gunshot wounds — 17.7%, the latter being the result of vagueness of the clinical picture. The clinical signs are most pronounced in the cases of stab and slash wounds to the heart.