Ulus Travma Acil Cerrahi Derg. 2007; 13(2): 135-141

Penetran kalp yaralanmalarý

Ayþen Aksöyek, Ufuk Tütün, Seyhan Babaroðlu, Ali Ýhsan Parlar, Ahmet Tulga Ulus, Salih Fehmi Katýrcýoðlu
Türkiye Yüksek Ýhtisas Hastanesi, Kalp Ve Damar Cerrahisi, Ankara, Türkiye

AMAÇ: Bu çalýþmada penetran kalp yaralanmasý olan hastalar deðerlendirildi.
GEREÇ-YÖNTEM: Mayýs 1994 ile Eylül 2005 tarihleri arasýnda kalp yaralanmasý þüpesiyle hastanemize gönderilen 25 hastanýn 22’sinde kardiyak yaralanma vardý. Hastalarýn tetkikleri ile fiziksel ve cerrahi bulgularý retrospektif olarak deðerlendirildi.
BULGULAR: Ekokardiyografi, hemodinamisi stabil olan 11 hastaya yapýlabilmiþ ve bir yanlýþ pozitif hariç tümünde perikardiyal efüzyon gösterilmiþtir. Bir hastada sol internal torasik arter ve ven yaralanmasý vardý. 17 hastada (%77) kalp tamponadý vardý. Hastalarda sað ventrikül (n=10, %45,5), sol ventrikül (n=7, %31,8), sol ön inen arteri içeren sol ventrikül (n=2, %9,1), sað atriyum (n=1, %4,5) perikardiyal hematom (n=2, %9,1) yaralanmasý vardý. Hastalarýn ortalama fizyolojik indeksi (PI) 10,68±5,63, penetran kardiyak travma indeksi 14,09±6,3, penetran torasik travma indeksi (PTTI) 17±8,84 ve Amerikan Travma Cerrahisi Birliðinin sýnýflamasýna göre ortalama organ hasarý skoru (AAST/OIS) 3,86±1,25 idi. Altý olgu kaybedildi (mortalite %27,3). Bu hastalarýn PI, PCTI, PTTI ve AAST/OIS skorlarý kurtulanlara göre daha yüksekti (p<0,05). Tamponat mevcudiyeti ve karýn yaralanma sýklýðý bakýmýndan fark yokken, sol ventrikül ve sol ön inen arter ve akciðer yaralanmasý kaybedilen hastalarda daha sýk bulundu.
SONUÇ: Penetran kalp yaralanmasý nedeniyle kaybedilen hastalar, saðkalanlara göre daha aðýr yaralanmalara ve daha yüksek PI, PCTI, PTTI ve AAST/OIS skorlarýna sahip olmaktadýr.

Anahtar Kelimeler: Ekokardiyografi, penetran kalp yaralanmasý; prekordiyal penetran yaralanmalar; travmatik kalp tamponadý.

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Penetrating cardiac injuries

Ayþen Aksöyek, Ufuk Tütün, Seyhan Babaroðlu, Ali Ýhsan Parlar, Ahmet Tulga Ulus, Salih Fehmi Katýrcýoðlu
Department Of Cardiovascular Surgery, Türkiye Yüksek Ýhtisas Trainingand Research Hospital, Ankara, Turkey.

BACKGROUND: This study was planned to evaluate patients with penetrating cardiac injury. METHODS: Twenty-two patients had cardiac injury among twenty-five patients who had been referred to our hospital with a suspicion of this diagnosis. Data of the patients were retrospectively evaluated. RESULTS: Echocardiography could be performed in 11 patients with stable haemodynamics and pericardial effusion was established in all of them with one false positive result. The patient with false positive result had left internal thoracic artery and venous injury. Cardiac tamponade was seen in 17 (77%) patients. Injury sites were right ventricle 10 (45.5%), left ventricle 7 (31.8%), left ventricle consisting left anterior descending artery 2 (9.1%), right atrium 1 (4.5%) and pericardial injuries and hematoma 2 (9.1%). The mean physiologic index (PI) of the patients was 10.68±5.63, penetrating cardiac trauma index was (PCTI) 14.09±6.3, penetrating thoracic trauma index (PTTI) was 17±8.84 and organ injury scale according to the American Association for the Surgery of Trauma (AAST/OIS) was 3.86±1.25. Mortality rate was 27.3% with 6 out of 22 patients. PI, PCTI, PTTI and AAST/OIS scores of the non-survivors were significantly higher than those of the survivors (p<0.05). While there was no difference between survivors and non-survivors regarding the presence of tamponade and the frequency of the associated abdominal injury, left ventricular and left anterior descending artery injuries and associated lung injuries were more common in non-survivors (p<0.05). CONCLUSION: Non-survivors with penetrating cardiac injury have higher PI, PCTI, PTTI and AAST/OIS scores and they are more severely injured patients comparing to the survivors.

Keywords: Echocardiography, penetrating cardiac injuries; precardial stab wounds; traumatic cardiac tamponade.

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