Penetrating heart wounds repaired without cardiopulmonary bypass. Evaluation and follow-up of recent war injuries.

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.