• Journal of Chest Surgery
• /
• 제22권5호
• /
• pp.760-765
• /
• 1989

Cardiac injury remains one of the most spectacular injuries which the present day cardiac surgeon is called upon to treat. Eight consecutive patients with penetrating or blunt injury to the heart underwent operation at the Department of Thoracic and Cardiovascular Surgery, Masan Koryo General Hospital from April 22 88 to April 6 89. l. Among the 8 cases of cardiac injured patients, 7 cases were penetrating injury [stab injury] and one case was blunt injury [traffic accident]. 2. The site of cardiac injury was LV mainly and the next RV, SVC-RA junction in order. 3. The all patients were admitted to our hospital via ER and most of cases, CVP was elevated above 15 cmH2O and 7 of 8 cases were shock state. 4. In 6 of 8 cases revealed cardiomegaly in simple chest X * ray. 5. 7 cases were operated through the median sternotomy, 1 case the right anterolateral thoracotomy. 6. Associated injuries in penetrating cardiac injury were hemothorax, pneumothorax, sternal fracture, lung laceration, LAD transaction in blunt injury, hemoperitoneum.

• Journal of Trauma and Injury
• /
• 제30권4호
• /
• pp.166-172
• /
• 2017

Purpose: Thoracic traumas represent 10-15% of all traumas and are responsible for 25% of all trauma mortalities. Traumatic cardiac injury (TCI) is one of the major causes of death in trauma patients, rarely present in living patients who are transferred to the hospital. TCI is a challenge for trauma surgeons as it provides a short therapeutic window and the management is often dictated by the underlying mechanism and hemodynamic status. This study is to describe our experiences about emergency cardiac surgery in TCI. Methods: This is a retrospective clinical analysis of patients who had undergone emergency cardiac surgery in our trauma center from January 2014 to December 2016. Demographics, physiologic data, mechanism of injuries, the timing of surgical interventions, surgical approaches and outcomes were reviewed. Results: The number of trauma patients who arrived at our hospital during the study period was 9,501. Among them, 884 had chest injuries, 434 patients were evaluated to have over 3 abbreviated injury scale (AIS) about the chest. Cardiac surgeries were performed in 18 patients, and 13 (72.2%) of them were male. The median age was 47.0 years (quartiles 35.0, 55.3). Eleven patients (61.1%) had penetrating traumas. Prehospital cardiopulmonary resuscitations (CPR) were performed in 4 patients (22.2%). All of them had undergone emergency department thoracotomy (EDT), and they were transferred to the operating room for definitive repair of the cardiac injury, but all of them expired in the intensive care unit. Most commonly performed surgical incision was median sternotomy (n=13, 72.2%). The majority site of injury was right ventricle (n=11, 61.1%). The mortality rate was 22.2% (n=4). Conclusions: This study suggests that penetrating cardiac injuries are more often than blunt cardiac injury in TCI, and the majority site of injury is right ventricle. Also, it suggests prehospital CPR and EDT are significantly responsible for high mortality in TCI.

• Journal of Trauma and Injury
• /
• 제30권1호
• /
• pp.21-23
• /
• 2017

Penetrating cardiac injury caused by nail gun is an uncommon life-threatening condition characterized by a rapidly severe hemodynamic status compromise. We report non-contrast-enhanced CT findings of a right ventricle myocardium injury leading to a fluid collection in the pericardial space with the same attenuation as blood. The CT findings well depicted the pathological feature of a significant cardiac injury and may be helpful for the surgical management.

• Journal of Trauma and Injury
• /
• 제36권3호
• /
• pp.180-186
• /
• 2023

Purpose: The purpose of this study was to report the treatment results of patients with traumatic cardiac tamponade after the opening of Jeju Regional Trauma Center. Methods: We analyzed the treatment outcomes of patients with traumatic cardiac tamponade who were treated at Jeju Regional Trauma Center from January 2018 to August 2022. Results: Seven patients with traumatic cardiac tamponade were treated. The male to female ratio was 1.33:1 (four male and three female patients) and the average age was 60.3±7.2 years. The mechanism of injury was blunt trauma in six cases and penetrating injury in one case. Upon arrival at the emergency department, pericardiostomy was performed in four cases, and an emergency operation was performed in six cases. Pericardiostomy alone was performed in one patient, who had cardiac tamponade due to extrapericardial suprahepatic inferior vena cava rupture. The causes of cardiac tamponade were right atrium appendage rupture in one case, right ventricle rupture in one case, inferior vena cava rupture in two cases, right atrium and left atrium rupture in one case, both atria and left ventricle rupture in one case, and intercostal artery rupture in one case. In three cases, intraoperative cardiopulmonary bypass was required. Two of the seven patients died (mortality rate, 28.5%). Conclusions: Relatively favorable treatment results were observed for traumatic cardiac tamponade patients after Jeju Regional Trauma Center was established.

• Journal of Trauma and Injury
• /
• 제25권4호
• /
• pp.287-290
• /
• 2012

Cardiac rupture after blunt trauma is very rare and caval injury is even rarer. However, cardiac rupture after blunt trauma is associated with very high mortality and can occur without a high speed collision or severe thoracic injury. Symptoms are not expressed in all patients in the early stage, so the condition is easily overlooked if patients have an associated injury, minimal thoracic injury or relatively stable vital signs. We report the successful management of two cases of vena caval injury after blunt trauma with slight thoracic injury.

• Journal of Trauma and Injury
• /
• 제34권4호
• /
• pp.242-247
• /
• 2021

Purpose: Blunt cardiac injuries (BCI) have a wide clinical spectrum, ranging from asymptomatic myocardial contusion to cardiac rupture and death. BCIs rarely require surgical intervention, but can be rapidly fatal, requiring prompt evaluation and surgical treatment in some cases. The aim of this study was to identify potential factors associated with in-hospital mortality after surgery in patients with BCI. Methods: The medical records of 15 patients who had undergone emergency cardiac surgery for BCI between January 2014 and August 2020 were retrospectively reviewed. We included trauma patients older than 18 years admitted to Regional Trauma Center, Gachon University Gil Medical Center during the study period. Clinical and laboratory variables were compared between survivors and non-survivors. Results: Non-survivors showed a significantly higher Injury Severity Score (p=0.001) and Abbreviated Injury Scale in the chest region (p=0.001) than survivors. American Association for the Surgery of Trauma-Organ Injury Scale Grade V injuries were significantly more common in non-survivors than in survivors (p=0.031). Non-survivors had significantly more preoperative packed red blood cell (PRBC) transfusions (p=0.019) and were significantly more likely to experience preoperative cardiac arrest (p=0.001) than survivors. Initial pH (p=0.010), lactate (p=0.026), and base excess (BE; p=0.026) levels showed significant differences between the two groups. Conclusions: Initial pH, lactate, BE, ventricular injury, the amount of preoperative PRBC transfusions, and preoperative cardiac arrest were potential predictors of in-hospital mortality.

• Journal of Chest Surgery
• /
• 제17권4호
• /
• pp.715-722
• /
• 1984

From 1978 to April 30 84 thirteen cases of cardiac injured patients were operated under general anesthesia at Department of Thoracic and Cardiovascular Surgery in Chonnam National University. These patients were divided Into two groups according to their cause of trauma: Group 1, penetrating cardiac injury and Group II, blunt cardiac injury. 1.In 7 cases of Group 1, 6 cases were stab wound and one case was gunshot wound, and among 6 cases of Group II, 3 cases traffic accident, 2 cases pedestrian, 1 case agrimotor accident. 2.The sites of cardiac injury in penetrating trauma were right ventricle mainly and the next left ventricle and in blunt trauma right ventricle, myocardial contusion, right atrium, and inferior vena cava in order. 3.In most of cases central venous pressure was elevated above 15 cmH2O and in 5 of 13 cases revealed cardiomegaly in simple chest X-ray. 4.The relationship between the condition on arrival and the time to operation is not significant. 5.Associated injuries in penetrating cardiac trauma were hemothorax, pneumothorax, laceration of lung and in blunt trauma hemothorax, sternal fracture, rib fracture and pneumothorax in order. 6.One case of gunshot injury died after operation.

• Journal of Chest Surgery
• /
• 제25권1호
• /
• pp.66-72
• /
• 1992

From March 1986 to March 1991, 29 patients were operated due to cardiac tamponade at the Department of Thoracic and Cardiovascular Surgery, Masan Koryo General Hospital. Among them, 19cases were traumatic origin and 10 were Non traumatic origin. A] Traumatic cardiac tamponade Out of 19 cases, 12 cases were resulted from penetrating injury and 7 cases from trauma. Average time interval from arrival to operation was 91 minutes[15min.~8.5hr.] in penetrating injury group. On the other hand, average time of in cases of blunt trauma was more than 3hours because of the difficulties in diagnosis. Four deaths occured in 19 cases [mortality rate: 21.1%] 3 in blunt trauma group[42.9%] and 1 in penetrating group[8.3%]. In view of our experience, the prognosis was closely correlated with injury mode, initial vital sign and mental status. There was no close correlation between prognosis and cardiac injury site. B] Non traumatic cardiac tamponade The etiologies were malignancy[4], non-spesific pericarditis[3], tuberculosis[1], pyogenic[1] and cardiomyopathy[1]. All of the cases in which performed tube pericardiostomy were the cases that showed no response to conservative treatment and repeat per-icardiocentesis. There was one posoperative death.

• Clinical and Experimental Pediatrics
• /
• 제45권2호
• /
• pp.208-213
• /
• 2002

목 적 : 수술 중, 후의 심근 손상은 선천성 심질환에 대한 개심술 후 심장 기능 부전의 주원인이다. 이 연구에서는 심근 세포에서만 발견되는 cardiac troponinI를 측정함으로서 수술 중, 후 심근 손상 정도와 회복 여부를 반영할 생화학적 표지자로서의 가치를 확인하고자 하였다. 방 법: 2001년 4월부터 7월까지 선천성 심질환으로 진단받고 개심술을 위해 본원에 입원한 환아 34명을 대상으로 하였다. Cardiac troponin I 치의 측정을 위해 술전 24시간 이내, 술후 1, 2, 3, 7일째에 각각 채혈을 시행했고, CPB 시간, ACC 시간, 기도 삽관시간, 수술 후 입원 기간을 측정하였다. 결 과 : Cardiac troponin I 치는 수술 후 1일째가 수술 전에 비해 유의한 증가가 있었고, 2, 3, 7일째에는 점차적으로 유의한 감소를 보였다. 심질환 별로는 수술 후 1일째 대혈관 전위에서 cardiac troponin I 치가 가장 높았고, 활로씨 4징, 방실중격결손, 심실중격결손, 심방중격결손 순으로 높은 치를 나타내었다. 심장폐 우회술 시간이 길수록, ACC 시간이 길수록 수술 후 1일째 cardiac troponin I 농도가 높았고, cardiac troponin I 농도가 높을수록 기도삽관 시간이 길었으나 입원 기간과는 상관관계가 없었다. 결 론: 개심술 후 시간에 따라, 개심술을 시행한 심질환에 따라 cardiac troponin I 농도의 의미 있는 증가와 점차적인 감소를 보임으로써 cardiac troponinI는 개심술 후 심근 손상의 정도 및 심근 손상에서의 회복 여부를 반영하는 생화학적 표지자로 가치가 있을 것으로 생각된다.

• Journal of Chest Surgery
• /
• 제49권6호
• /
• pp.435-442
• /
• 2016

Background: Blunt traumatic cardiac rupture is rare. However, such cardiac ruptures carry a high mortality rate. This study reviews our experience treating blunt traumatic cardiac rupture. Methods: This retrospective study included 21 patients who experienced blunt traumatic cardiac rupture from 1999 to 2015. Every patient underwent surgery. Several variables were compared between survivors and fatalities. Results: Sixteen of the 21 patients survived, and 5 (24%) died. No instances of intraoperative mortality occurred. The most common cause of injury was a traffic accident (81%). The right atrium was the most common location of injury (43%). Ten of the 21 patients were suspected to have cardiac tamponade. Significant differences were found in preoperative creatine kinase-myocardial band (CK-MB) levels (p=0.042) and platelet counts (p=0.004) between the survivors and fatalities. The patients who died had higher preoperative Glasgow Coma Scale scores (p=0.007), worse Trauma and Injury Severity Scores (p=0.007), and higher Injury Severity Scores (p=0.004) than those who survived. Conclusion: We found that elevated CK-MB levels, a low platelet count, and multi-organ traumatic injury were prognostic factors predicting poor outcomes of blunt cardiac rupture. If a patient with blunt traumatic cardiac rupture has these factors, clinicians should be especially attentive and respond promptly in order to save the patient's life.