Penetrating injuries of the heart and the great vessels.

An account of a personal experience with 18 cases of penetrating injuries of the heart and/or the great vessels due to shrapnels or bullets during the civil war in Lebanon is presented. Six of 18 patients were children. A survey of the literature did not disclose a description of these injuries in the pediatric group. Seven patients had signs of cardiac tamponade preoperatively. Fifteen patients had concomitant injuries to other organs. Emergency thoracotomy was used in patients within two hours after arrival to the hospital and was not preceded by pericardiocentesis. Cardio-pulmonary bypass was not used in any patient. There was one death which was related to associated injuries, giving a mortality rate of 5.5%. All survivors have resumed regular activities. Though the author is basically a pediatric surgeon, his expertise had to be stretched during the civil war to cover casualties in all age groups.