Hromalik Larry R, Wall Matthew J, Mattox Kenneth L, Tsai Peter I
Department of Surgery, University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, HI, USA.
Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Mediastinum. 2023 Feb 22;7:15. doi: 10.21037/med-22-18. eCollection 2023.
Penetrating cardiac trauma is rare but can cause life-threatening complications. Survival is dependent on prompt diagnosis and treatment. Given the low incidence and life-threatening implications, it is difficult to study in large prospective studies. The current literature regarding penetrating cardiac trauma comes primarily from large, experienced trauma centers and military sources. Understanding the history, current literature and even expert opinion can help with effectively treating injury promptly to maximize survival after penetrating cardiac trauma. We aimed to review the etiology and history of penetrating cardiac trauma. We review the prehospital treatment and initial diagnostic modalities. We review the incisional approaches to treatment including anterolateral thoracotomy, median sternotomy and subxiphoid window. The repair of atrial, ventricular and coronary injuries are also addressed in our review. The purpose of this paper is to perform a narrative review to better describe the history, etiology, presentation, and management of penetrating cardiac trauma.
A narrative review was preformed synthesizing literature from MEDLINE and bibliographic review from identified publications. Studies were included based on relevance without exclusion to time of publication or original publication language.
Sonographic identification of pericardial fluid can aid in diagnosis of patients too unstable for CT. Anterolateral thoracotomy should be used for emergent repairs and initial stabilization. A median sternotomy can be used for more stable patients with known injuries. Carefully placed mattress sutures can be useful for repair of injuries surrounding coronary vessels to avoid devascularization.
Penetrating cardiac trauma is life threatening and requires prompt workup and treatment. Trauma algorithms should continue to refine and be clear on which patients should undergo an emergency department (ED) thoracotomy, median sternotomy and further imaging.
穿透性心脏创伤较为罕见，但可导致危及生命的并发症。生存取决于及时的诊断和治疗。鉴于其低发病率和危及生命的影响，很难进行大型前瞻性研究。目前关于穿透性心脏创伤的文献主要来自大型、经验丰富的创伤中心和军事来源。了解其病史、当前文献甚至专家意见有助于及时有效地治疗损伤，以最大限度提高穿透性心脏创伤后的生存率。我们旨在回顾穿透性心脏创伤的病因和病史。我们回顾院前治疗和初始诊断方式。我们回顾治疗的切口入路，包括前外侧开胸术、正中胸骨切开术和剑突下窗口。我们的综述还涉及心房、心室和冠状动脉损伤的修复。本文的目的是进行叙述性综述，以更好地描述穿透性心脏创伤的病史、病因、表现和管理。
进行叙述性综述，综合来自MEDLINE的文献和已识别出版物的书目综述。纳入的研究基于相关性，不排除出版时间或原始出版语言。
超声心动图识别心包积液有助于诊断病情过于不稳定而无法进行CT检查的患者。前外侧开胸术应用于紧急修复和初始稳定。正中胸骨切开术可用于伤情已知且病情较稳定的患者。仔细放置的褥式缝线有助于修复冠状动脉周围的损伤，避免血管化不足。
穿透性心脏创伤危及生命，需要迅速检查和治疗。创伤治疗方案应不断完善，明确哪些患者应接受急诊科开胸术、正中胸骨切开术和进一步影像学检查。
