Catipović-Veselica K, Sincić V, Durijanĕk J, Kozmar D, Burić D, Juranić B, Kristek J, Amidzić V
Department of Cardiology, Clinical Hospital Osijek, Croatia.
Tex Heart Inst J. 1993;20(2):94-8.
Penetrating cardiac injuries requires urgent management. Between September 1991 and June 1992, 10 patients with penetrating cardiac injuries sustained in war were treated at our hospital in Croatia, which does not have cardiopulmonary bypass facilities. Seven of these patients survived cardiorrhaphy and were discharged from the hospital, subject to follow-up. In 5 of the survivors, the injuries were inflicted by fragments from explosive devices; in 1 survivor, by a bullet; and in 1 survivor, by a rib fragment. The left ventricle was lacerated in 4 patients, the right ventricle in 2, the left atrium in 1, and the right atrium in 2. One patient had sustained laceration of the left anterior descending coronary artery in addition to a left ventricular laceration. During early post-cardiorrhaphy evaluation, all patients showed ST segment changes on electrocardiography. The most common echocardiographic findings were pericardial effusion in 5 patients (71%) and intramyocardial foreign bodies in 3 patients (43%). After 5 to 10 months of follow-up, the most common echocardiographic findings were enlargement of the injured chamber in 6 patients (86%), intramyocardial foreign bodies in 3 patients (43%), and hypokinesis of the injured wall in 2 patients (29%). Resting electrocardiographic results and exercise testing results were normal in all patients. One patient had arrhythmias during 24-hour Holter monitoring. Patients surviving operation had a rapid recovery, and were asymptomatic when last seen at follow-up. This demonstrates that treatment of penetrating injuries of the heart can be very successful, at least in the short term, even in hospitals without cardiopulmonary bypass facilities.
穿透性心脏损伤需要紧急处理。1991年9月至1992年6月期间，克罗地亚一家没有体外循环设备的医院收治了10例战争中遭受穿透性心脏损伤的患者。其中7例患者心脏缝合术后存活并出院，接受随访。5例幸存者的损伤由爆炸装置碎片造成；1例由子弹造成；1例由肋骨碎片造成。4例患者左心室撕裂，2例右心室撕裂，1例左心房撕裂，2例右心房撕裂。1例患者除左心室撕裂外，还伴有左前降支冠状动脉撕裂。在心脏缝合术后早期评估中，所有患者心电图均显示ST段改变。最常见的超声心动图表现为5例患者（71%）出现心包积液，3例患者（43%）出现心肌内异物。随访5至10个月后，最常见的超声心动图表现为6例患者（86%）受伤腔室扩大，3例患者（43%）出现心肌内异物，2例患者（29%）受伤壁运动减弱。所有患者静息心电图结果和运动试验结果均正常。1例患者在24小时动态心电图监测期间出现心律失常。手术存活的患者恢复迅速，随访时最后一次见到时无症状。这表明，即使在没有体外循环设备的医院，心脏穿透伤的治疗至少在短期内也可能非常成功。
