Major Thoracic Vessels and Cardiac Trauma: Case Series from a centre in a developing country

75% of all trauma-related deaths are related to Thoracic Trauma. Very few penetrating cardiac trauma patients arrive at the hospital alive. Due to the high prevalence an understanding of the pathogenesis, manifestations, and management of cardiac trauma is becoming increasingly important to medical personnel.
We retrospectively reviewed the files of 169 patients with a preoperative diagnosis of vascular injury that underwent management at the Aga Khan University Hospital (AKUH) during 2001 to 2006. Out of these patients 13 had cardiovascular and cardiac injuries.
There were 23% (n=3) Cardiac injuries, two right ventricle injuries and in one both the ventricles were injured. Great vessel injuries included; Pulmonary artery (n=2), Inferior Vena cava (n=1), Left Carotid Artery (n=1), Left Subclavian Artery (n=2) and Right Subclavian Artery (n=3). 53.8% of the patients suffered from post-operative complications. The overall mortality of patients was 15.4%.
We believe that in comparison to the past the inevitable delay in the diagnosis lead to unsuccessful thoracotomies, late transfers to the operating room and physiological deterioration of the patients. As the incidence of trauma is increasing worldwide it is essential for surgeons to be prepared to handle cardiovascular and cardiac trauma injuries immediately, as delay can adversely affect the outcome in terms of both morbidity and mortality.