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Penetran kalp yaralanmalarında sekiz yıllık tecrübelerimiz: Çok merkezli retrospektif kohort çalışma

Year 2020, Volume: 4 Issue: 5, 387 - 389, 01.05.2020
https://doi.org/10.28982/josam.729522

Abstract

Amaç: Penetran kalp yaralanmaları (PKY) sıklıkla kesici-delici alet yaralanmaları sonucu gelişir ve perikard ile miyokard hasarına sebep olarak miyokardial disfonksiyona yol açar. Penetran göğüs yaralanmalarında görülen mortalite oranının %50’den fazlasından PKY sorumludur. Bu çalışmanın amacı PKY sebebiyle kalp cerrahisi uygulanan hastaların sonuçlarını değerlendirmektir.
Yöntemler: Bu çalışma retrospektif kohort çalışması olarak tasarlanmıştır. Van Yüzüncü Yıl Üniversitesi Hastanesi, Yozgat Şehir Hastanesi ve Bozok Üniversitesi Hastanesinde 2012 ve 2019 yılları arasında PKY sebebiyle kalp cerrahisi uygulanan 27 hasta klinik bulguları, tedavi ve cerrahi teknikleri açısından retrospektif olarak değerlendirilmiştir.
Bulgular: Hastaların 24’ü erkek 3’ü kadın, 24’ü erkek idi. Yaş ortalaması 34,2 (13,2) (14 ila 65 yaş aralığında) idi. İki vakada ateşli silah yaralanması, 25 vakada kesici delici alet yaralanması mevcuttu. Hastaneye olay yerinden intikal süresi 29,7 (14,6) (15 ila 98 dakika aralığında) dakikaydı. 27 hastada 29 kardiyak yaralanma mevcuttu. Bu vakaların 18’inde (%62,06) izole kalp yaralanması, ve 11’inde (%37,94) birden fazla yaralanma mevcuttu. İki hastada koroner arter yaralanması vardı. On dört hasta (%51,8) transtorasik ekokardiyografi, 12’si (%44,5) klinik bulgular ve bir hasta (%3,7) kontrastlı toraks tomografisi sonrası operasyona alındı. Tamponat kliniği veren vakalarda perikardiyal kan hacmi ortalama 290 ml (140-460 ml aralığında) idi. En sık yaralanan kalp bölgesi sağ ventrikül idi ve ikinci sırada sol ventrikül gelmekteydi. İki hastada koroner arter yaralanması tespit edildi. Genel mortalite oranı %44 olarak tespit edildi.
Sonuç: Mortalite ve morbiditenin azaltılmasında olay yerinden başlayarak erken tanı, doğru ve hızlı transport, deneyimli cerrahi travma ekipleri ile multidisipliner yaklaşım faydalı olacaktır. PKY’de hayatta kalmayı artırmamız için sağlık hizmetlerinin geliştirilmesinin yanı sıra bireysel silahlanmanın önlenmesine özellikle dikkat çekmek isteriz.

References

  • 1. Tyburski JG, Astra L, Wilson RF, Dente C, Steffes C. Factors affecting prognosis with penetrating wounds of the heart. J Trauma. 2000;48:587-91.
  • 2. Ivatury RR, Nallathambi MN, Roberge RJ, Rohman M, Stahl W. Penetrating thoracic injuries: infield stabilization vs. prompt transport. J Trauma. 1987;27:1066-73.
  • 3. Akay T. Kalp ve damar yaralanmaları. TTD Toraks Cerrahisi Bulteni. 2010;1(1):78-86.
  • 4. Bilroth T. The scalpel and the heart. in Richardson RG (ed): The Scalpel and the Heart. New York, Scribner' s, 1970, p27
  • 5. Arikan S, Yücel AF, Kocakuşak A, Dadük Y, Adaş G, Onal MA. Retrospective analysis of the patients with penetrating cardiac trauma. Ulus Travma Acil Cerrahi Derg. 2003;9:124-8.
  • 6. Altınbaş, Ö , Tanyeli, Ö. Surgically managed gunshot injury of the heart; Bullet in the right coronary artery. J Surg Med. 2018;2(2):193-4. doi: 10.28982/josam.407946
  • 7. Dereli Y, Özdemir R, Ağrış M, Öncel M, Hoşgör K, Özdiş AS. Penetrating cardiac injuries: assessment of 21 patients. Ulus Travma Acil Cerrahi Derg. 2012;18(5):441-5.
  • 8. Campbell NC, Thomson SR, Muckart DJ, Meumann CM, Van Middelkoop I, Botha JB. Review of 1198 cases of penetrating cardiac trauma. Br J Surg. 1997;84:1737-40.
  • 9. Göz M, Çakır Ö, Eren MN. Penetran kalp yaralanmaları; mortalite belirleyicilerinin analizi. Ulus Travma Acil Cerrahi Derg. 2009;15(4):362-6.
  • 10. Naughton MJ, Brissie RM, Bessey PQ, at all:Demography of penetrating cardiac trauma. Ann Surg. 1989;209:676-83.
  • 11. Çakır Ö, Eren Ş, Balcı AE, Özçelik C, Eren N. Penetran kalp yaralanmaları. Türk Göğüs Kalp Damar Cer Derg. 1999;7:112-6.
  • 12. Chang WY, Hsu JY, Chang YP, Chao CS, Chang KJ. The successful management of a penetrating cardiac injury in a regional hospital: A Case Report. J Emerg Crit. Care Med 2008;19:160-5.
  • 13. Ekim H, Basel H, Odabasi D, Tuncer M, Gumrukcuoglu HA. Management of penetrating heart and accompanying lung injuries. Pak J Med Sci. 2010;26(3):526-31.
  • 14. Jebara VA, Scede B: Penetrating Wounds to the Heart: A wartime experience. Ann Thorac Surg. 1989;47:250-4.
  • 15. Kocamaz F, Beşerli K, Kutluk E, Eryüksel B, Ahat E. Penetran Kalp Yaralanmaları. Istanbul Tıp Dergisi. 1998;1:1-3.
  • 16. Attar S, Suter CM, Hankins JR, Sequeira A, McLaughlin JS. Penetrating cardiac injuries. Ann Thorac Surg. 1991;51:711-6.
  • 17. Cihan HB, Ege E, Gülcan Ö, Yaşaroğlu O, Türköz R. Penetran Kalp Yaralanmaları. GKDC Dergisi. 1998;6:217-20.
  • 18. Henderson VJ, Smith RS, Fry WR, Morabito D, Peskin GW, Barkan H, et al. Cardiac injuries; Analysis of an unselected series of 251 cases. J Trauma. 1994;36:341-8.
  • 19. Reece IJ, Davidson KG. Penetrating cardiac injuries in the United Kingdom. Thorax. 1983;38:81-3.
  • 20. Martin LF, Mavroudis C, Dyess DL, Gray LA. The first 70 years experience managing cardiac disruption due to penetrating and blunt injuries at the University of Lousville. Am Surg. 1986;52:14-9.
  • 21. Mihmanlı M, Erzurumlu K, Türkay B, Kalyoncu A, Güney M. Penetran Kalp Yaralanmaları. GKD Cer.Derg. 1994;2:270-3.

Eight-year experiences in penetrating cardiac injury: A multi-center retrospective cohort study

Year 2020, Volume: 4 Issue: 5, 387 - 389, 01.05.2020
https://doi.org/10.28982/josam.729522

Abstract

Aim: Penetrating cardiac injuries (PCI) are mostly caused by sharp objects and comprise pericardial and myocardial deformation, which lead to myocardial dysfunction. Fifty percent of overall mortality in penetrating chest injuries are caused by PCIs. The aim of this study is to evaluate the results of patients who underwent cardiac surgery due to PCIs.
Methods: In this retrospective cohort study, twenty-seven cases undergoing cardiac surgery due to PCI in Van Yuzuncu Yil University Hospital, Yozgat City Hospital and Bozok University Hospital between 2012 and 2019 were evaluated in terms of clinical findings, treatment methods and surgical techniques.
Results: There were 3 females and 24 males. The mean age was 34.2 (13.2) years (range: 14-65 years) years. Firearms caused two and penetrating stab wounds caused twenty-five injuries, respectively. The patients were transported to the hospital within a mean time of 29.7 (14.6) minutes (range: 15-98 minutes). 29 injuries were observed in 27 patients, 18 (62.06%) of which were isolated cardiac injuries, and 11 (37.94%) were mixed type. Fourteen patients (51.8%) were operated following a transthoracic echocardiography, 12 patients (44.5%) due to clinical findings and one patient (3.7%) due to the contrast-enhanced thoracic computed tomography (TCT) result. The mean pericardial blood volume was 290 mL (range 140-460 mL) in patients with a cardiac tamponade. The most frequently injured cardiac section was the right ventricle, followed by the left ventricle. Coronary artery injuries were observed in two patients. Overall mortality rate was 44%.
Conclusion: Early diagnosis, fast and safe transport, providing qualified surgical equipment, and a multidisciplinary approach are mandatory to decrease mortality and morbidity rates. It is also crucially important to prevent individual armament in preventing penetrating cardiac surgery cases.

References

  • 1. Tyburski JG, Astra L, Wilson RF, Dente C, Steffes C. Factors affecting prognosis with penetrating wounds of the heart. J Trauma. 2000;48:587-91.
  • 2. Ivatury RR, Nallathambi MN, Roberge RJ, Rohman M, Stahl W. Penetrating thoracic injuries: infield stabilization vs. prompt transport. J Trauma. 1987;27:1066-73.
  • 3. Akay T. Kalp ve damar yaralanmaları. TTD Toraks Cerrahisi Bulteni. 2010;1(1):78-86.
  • 4. Bilroth T. The scalpel and the heart. in Richardson RG (ed): The Scalpel and the Heart. New York, Scribner' s, 1970, p27
  • 5. Arikan S, Yücel AF, Kocakuşak A, Dadük Y, Adaş G, Onal MA. Retrospective analysis of the patients with penetrating cardiac trauma. Ulus Travma Acil Cerrahi Derg. 2003;9:124-8.
  • 6. Altınbaş, Ö , Tanyeli, Ö. Surgically managed gunshot injury of the heart; Bullet in the right coronary artery. J Surg Med. 2018;2(2):193-4. doi: 10.28982/josam.407946
  • 7. Dereli Y, Özdemir R, Ağrış M, Öncel M, Hoşgör K, Özdiş AS. Penetrating cardiac injuries: assessment of 21 patients. Ulus Travma Acil Cerrahi Derg. 2012;18(5):441-5.
  • 8. Campbell NC, Thomson SR, Muckart DJ, Meumann CM, Van Middelkoop I, Botha JB. Review of 1198 cases of penetrating cardiac trauma. Br J Surg. 1997;84:1737-40.
  • 9. Göz M, Çakır Ö, Eren MN. Penetran kalp yaralanmaları; mortalite belirleyicilerinin analizi. Ulus Travma Acil Cerrahi Derg. 2009;15(4):362-6.
  • 10. Naughton MJ, Brissie RM, Bessey PQ, at all:Demography of penetrating cardiac trauma. Ann Surg. 1989;209:676-83.
  • 11. Çakır Ö, Eren Ş, Balcı AE, Özçelik C, Eren N. Penetran kalp yaralanmaları. Türk Göğüs Kalp Damar Cer Derg. 1999;7:112-6.
  • 12. Chang WY, Hsu JY, Chang YP, Chao CS, Chang KJ. The successful management of a penetrating cardiac injury in a regional hospital: A Case Report. J Emerg Crit. Care Med 2008;19:160-5.
  • 13. Ekim H, Basel H, Odabasi D, Tuncer M, Gumrukcuoglu HA. Management of penetrating heart and accompanying lung injuries. Pak J Med Sci. 2010;26(3):526-31.
  • 14. Jebara VA, Scede B: Penetrating Wounds to the Heart: A wartime experience. Ann Thorac Surg. 1989;47:250-4.
  • 15. Kocamaz F, Beşerli K, Kutluk E, Eryüksel B, Ahat E. Penetran Kalp Yaralanmaları. Istanbul Tıp Dergisi. 1998;1:1-3.
  • 16. Attar S, Suter CM, Hankins JR, Sequeira A, McLaughlin JS. Penetrating cardiac injuries. Ann Thorac Surg. 1991;51:711-6.
  • 17. Cihan HB, Ege E, Gülcan Ö, Yaşaroğlu O, Türköz R. Penetran Kalp Yaralanmaları. GKDC Dergisi. 1998;6:217-20.
  • 18. Henderson VJ, Smith RS, Fry WR, Morabito D, Peskin GW, Barkan H, et al. Cardiac injuries; Analysis of an unselected series of 251 cases. J Trauma. 1994;36:341-8.
  • 19. Reece IJ, Davidson KG. Penetrating cardiac injuries in the United Kingdom. Thorax. 1983;38:81-3.
  • 20. Martin LF, Mavroudis C, Dyess DL, Gray LA. The first 70 years experience managing cardiac disruption due to penetrating and blunt injuries at the University of Lousville. Am Surg. 1986;52:14-9.
  • 21. Mihmanlı M, Erzurumlu K, Türkay B, Kalyoncu A, Güney M. Penetran Kalp Yaralanmaları. GKD Cer.Derg. 1994;2:270-3.
There are 21 citations in total.

Details

Primary Language English
Subjects Cardiovascular Surgery
Journal Section Research article
Authors

Zafer Cengiz Er 0000-0001-7129-1157

Kıvanç Atılgan 0000-0001-9907-9879

Publication Date May 1, 2020
Published in Issue Year 2020 Volume: 4 Issue: 5

Cite

APA Er, Z. C., & Atılgan, K. (2020). Eight-year experiences in penetrating cardiac injury: A multi-center retrospective cohort study. Journal of Surgery and Medicine, 4(5), 387-389. https://doi.org/10.28982/josam.729522
AMA Er ZC, Atılgan K. Eight-year experiences in penetrating cardiac injury: A multi-center retrospective cohort study. J Surg Med. May 2020;4(5):387-389. doi:10.28982/josam.729522
Chicago Er, Zafer Cengiz, and Kıvanç Atılgan. “Eight-Year Experiences in Penetrating Cardiac Injury: A Multi-Center Retrospective Cohort Study”. Journal of Surgery and Medicine 4, no. 5 (May 2020): 387-89. https://doi.org/10.28982/josam.729522.
EndNote Er ZC, Atılgan K (May 1, 2020) Eight-year experiences in penetrating cardiac injury: A multi-center retrospective cohort study. Journal of Surgery and Medicine 4 5 387–389.
IEEE Z. C. Er and K. Atılgan, “Eight-year experiences in penetrating cardiac injury: A multi-center retrospective cohort study”, J Surg Med, vol. 4, no. 5, pp. 387–389, 2020, doi: 10.28982/josam.729522.
ISNAD Er, Zafer Cengiz - Atılgan, Kıvanç. “Eight-Year Experiences in Penetrating Cardiac Injury: A Multi-Center Retrospective Cohort Study”. Journal of Surgery and Medicine 4/5 (May 2020), 387-389. https://doi.org/10.28982/josam.729522.
JAMA Er ZC, Atılgan K. Eight-year experiences in penetrating cardiac injury: A multi-center retrospective cohort study. J Surg Med. 2020;4:387–389.
MLA Er, Zafer Cengiz and Kıvanç Atılgan. “Eight-Year Experiences in Penetrating Cardiac Injury: A Multi-Center Retrospective Cohort Study”. Journal of Surgery and Medicine, vol. 4, no. 5, 2020, pp. 387-9, doi:10.28982/josam.729522.
Vancouver Er ZC, Atılgan K. Eight-year experiences in penetrating cardiac injury: A multi-center retrospective cohort study. J Surg Med. 2020;4(5):387-9.