Increasing numbers of penetrating cardiac trauma in a new center

BACKGROUND
Our aim was to express the importance of emergency diagnosis and surgical approach in penetrating cardiac trauma patients.
METHODS
Koþuyolu Heart and Research Hospital moved to its new location in Cevizli Kartal in June 2005. Due to its close proximity to the main roads of the city, the number of trauma cases has increased tremendously. We have retrospectively examined our penetrating cardiac trauma cases treated between June 2005 and September 2008.
RESULTS
Twenty-six trauma cases were admitted to our clinic with penetrating cardiac trauma. Twenty of them were operated on an emergency basis. One (5%) had a gunshot wound while the other 19 (95%) had stab wounds. Four were female (20%) and 16 were male (80%). Average age of the patients was 24.9±10.1 (12-49) years. Telecardiography and transthoracic echocardiography were used for diagnosis. Surgical approaches were median sternotomy in 14 and left anterolateral thoracotomy in 6 cases. The right ventricle was damaged in 12, left ventricle in 7 and pulmonary artery in 1. Additionally, 5 patients had lung injury, 1 had brachiocephalic vein injury and 1 had coronary artery injury. One patient was re-explored for bleeding. There were two mortalities (10%) postoperatively.
CONCLUSION
Rapid transfer to the emergency department, accurate and quick diagnosis and aggressive surgical approach will increase survival in penetrating cardiac trauma.

Yeni bir merkezde artan penetran kardiyak travma vakalarý

AMAÇ
Penetran kardiyak yaralanma nedeniyle cerrahi tedavi gören hastalarda taný ve acil cerrahi yaklaþýmýn önemini vurgulamaktýr.
GEREÇ VE YÖNTEM
Koþuyolu Kalp Eðitim ve Araþtýrma Hastanesi, Haziran 2005 tarihinde Cevizli Kartal’daki yeni hizmet binasýna taþýndý. Bu bölgede hizmet binasýnýn þehrin ana arterlerine yakýn konumlanmasý nedeniyle travmalý olgularýn sayýsýnda artýþ söz konusudur. Bu çalýþmada, Haziran 2005-Eylül 2008 tarihleri arasýnda penetran kardiyak yaralanma tanýsýyla kliniðimize baþvuran olgular retrospektif olarak incelendi.

BULGULAR
Penetran kardiyak yaralanma ön tanýsýyla 26 hasta kliniðimize baþvurdu. Bu hastalarýn 20’sine cerrahi onarým iþlemi uygulandý. Olgularýn birinde (%5) ateþli silah, geri kalanýnda (%95) ise kesici delici alet ile yaralanma mevcuttu. Hastalarýn 4’ü (%20) kadýn, 16’sý (%80) erkekti. Yaþ ortalamasý 24,9±10,1 (12-49) idi. Tanýda klinik bulgulara ek olarak telekardiyografi ve transtorasik ekokardiyografi kullanýldý. Cerrahi onarýmda 14 hastada mediyan sternotomi ve 6 olguda sol anterolateral torakotomi uygulandý. Hastalarýn 12’sinde sað ventrikül, birinde pulmoner arter ve yedisinde sol ventrikül yaralanmasý vardý. Ýlave olarak beþ hastada akciðer, bir hastada brakiyosefalik ven ve bir hastada koroner arter yaralanmasý saptandý. Bir hasta kanama nedeniyle revizyona alýndý. Postoperatif dönemde iki hasta (%10) kaybedildi.
SONUÇ
Penetran kardiyak yaralanma olgularýnda hastalarýn hýzlý transferi, tanýnýn doðru ve çabuk koyulmasý ve agresif cerrahi onarým uygulanmasý ile hayatta kalma oranlarý artacaktýr.