PURPOSE: The most common cardiac injuries in the United States are blunt trauma from motor vehicle accidents or low-velocity trauma from stabbings. During military conflict, high-velocity injuries, including gunshot wounds (GSW) and fragment injury from improvised explosive devices (IED), are relatively more common. METHODS: This is a retrospective review of cases with high-velocity penetrating injury and suspected myocardial involvement during a 6-month period in Baghdad, Iraq, at a United States Army hospital during Operation Iraqi Freedom. RESULTS: Eleven cases survived to admission (GSW in 5, IED in 6). The mean age of the all-male cohort was 27 years (range, 3-54 years). Eight of the 11 patients (73%) were victims of polytrauma. The entrance involved the right ventricle (n = 3), right atrium (n = 2), left ventricle (n = 1), or mediastinum and pericardial reflections (n = 5). Echocardiography was performed in all 11 patients. In 7 patients, no foreign body was identifiable, and in 2 patients the foreign body was identified within the pericardial fat pad. Three patients were identified as having a suspected ventricular septal defect, ranging in size from 2 to 8 mm. The most common electrocardiographic abnormality was atrioventricular block and right bundle branch block. In 4 patients, the management of the chest injury was nonsurgical, and in 1 patient the treatment was a chest tube only. Four of the patients underwent median sternotomy, 1 underwent emergent lateral thoracotomy, and 1 underwent an infradiaphragmatic approach. CONCLUSION: This case series is too small to draw definitive conclusions; however, a multidisciplinary approach to high-velocity injuries with potential for cardiac involvement augments preoperative assessment for myocardial injury and may allow selective nonoperative management.
PURPOSE: The most common cardiac injuries in the United States are blunt trauma from motor vehicle accidents or low-velocity trauma from stabbings. During military conflict, high-velocity injuries, including gunshot wounds (GSW) and fragment injury from improvised explosive devices (IED), are relatively more common. METHODS: This is a retrospective review of cases with high-velocity penetrating injury and suspected myocardial involvement during a 6-month period in Baghdad, Iraq, at a United States Army hospital during Operation Iraqi Freedom. RESULTS: Eleven cases survived to admission (GSW in 5, IED in 6). The mean age of the all-male cohort was 27 years (range, 3-54 years). Eight of the 11 patients (73%) were victims of polytrauma. The entrance involved the right ventricle (n = 3), right atrium (n = 2), left ventricle (n = 1), or mediastinum and pericardial reflections (n = 5). Echocardiography was performed in all 11 patients. In 7 patients, no foreign body was identifiable, and in 2 patients the foreign body was identified within the pericardial fat pad. Three patients were identified as having a suspected ventricular septal defect, ranging in size from 2 to 8 mm. The most common electrocardiographic abnormality was atrioventricular block and right bundle branch block. In 4 patients, the management of the chest injury was nonsurgical, and in 1 patient the treatment was a chest tube only. Four of the patients underwent median sternotomy, 1 underwent emergent lateral thoracotomy, and 1 underwent an infradiaphragmatic approach. CONCLUSION: This case series is too small to draw definitive conclusions; however, a multidisciplinary approach to high-velocity injuries with potential for cardiac involvement augments preoperative assessment for myocardial injury and may allow selective nonoperative management.
Authors: T M Scalea; A Rodriguez; W C Chiu; F D Brenneman; W F Fallon; K Kato; M G McKenney; M L Nerlich; M G Ochsner; H Yoshii Journal: J Trauma Date: 1999-03
Authors: J A Asensio; B M Stewart; J Murray; A H Fox; A Falabella; H Gomez; A Ortega; C B Fuller; M D Kerstein Journal: Surg Clin North Am Date: 1996-08 Impact factor: 2.741
Authors: Nicole A Stassen; James K Lukan; David A Spain; Frank B Miller; Eddy H Carrillo; J David Richardson; Felix D Battistella Journal: J Trauma Date: 2002-10
Authors: J A Asensio; J D Berne; D Demetriades; L Chan; J Murray; A Falabella; H Gomez; S Chahwan; G Velmahos; E E Cornwell; H Belzberg; W Shoemaker; T V Berne Journal: J Trauma Date: 1998-06
Authors: Zhao-Wen Zong; Zhi-Nong Wang; Si-Xu Chen; Hao Qin; Lian-Yang Zhang; Yue Shen; Lei Yang; Wen-Qiong Du; Can Chen; Xin Zhong; Lin Zhang; Jiang-Tao Huo; Li-Ping Kuai; Li-Xin Shu; Guo-Fu Du; Yu-Feng Zhao Journal: Mil Med Res Date: 2018-10-04