Nier H, van der Horst W, Rivas-Martin J, Jünemann A
Med Klin. 1978 Jan 27;73(4):131-4.
Clinical signs of an acute penetrating wound of the heart not always are clear. Because of hemorrhage and reduced cardiac output during heart tamponade venous pressure not necessarily must be increased. If by pericardiocentesis an aspiration of blood is possible, diagnosis of a penetrating heart wound is of high probability; otherwise there is no diagnostic value of a negative pericardiocentesis. Only in a case of a very small cardiac wound pericardial drainage can be used as a sole therapeutic proceeding; clinical observation is mandatory and an emergency operation at all time must be possible. In most cases immediately thoracotomy with suture of the cardiac wound should be performed. Attention is necessary because of an injury of a coronary artery. Following this principle prognosis is good if the patient is reaching clinical treatment alive. Lethal outcome in 2 of our 12 reported cases in one of them is caused by refusing immediate surgical intervention by the patient himself, in the other by development of ischemic cardiac necrosis involving a papillary muscle after suturing a cardiac wound.
心脏急性穿透伤的临床体征并不总是很明显。由于心脏压塞时出血和心输出量减少，静脉压不一定会升高。如果通过心包穿刺能够抽出血液，则心脏穿透伤的诊断可能性很大；否则，心包穿刺阴性没有诊断价值。只有在心脏伤口非常小的情况下，心包引流才可作为唯一的治疗手段；必须进行临床观察，并且任何时候都必须能够进行急诊手术。在大多数情况下，应立即进行开胸手术并缝合心脏伤口。由于可能损伤冠状动脉，因此需要格外小心。遵循这一原则，如果患者能够存活至接受临床治疗，预后良好。在我们报告的12例病例中，有2例死亡，其中1例是因为患者本人拒绝立即进行手术干预，另1例是因为缝合心脏伤口后发生了涉及乳头肌的缺血性心肌坏死。
