Hikmet KOÇAK, Uğur KAYA, Abdurrahim ÇOLAK

Penetran kardiyak yaralanmalar:19 olgunun değerlendirilmesi

Amaç: Bu çalışmada, hastanemizde penetran kardiyak yaralanma nedeniyle cerrahi olarak tedavi edilen hastalar sunuldu.Çalışma planı: Ağustos 2001 - Ekim 2016 tarihleri arasında penetran kalp yaralanması ile hastanemize başvuran 19 erkek hasta (ort. yaş 32.7±17.3 yıl; dağılım 15-73 yıl) retrospektif olarak değerlendirildi. Hastaların klinik bulguları, tedavi şekilleri ve tedavi sonuçları kaydedildi.Bulgular: Tüm hastaların 16’sı delici kesici alet nedeniyle, üçü ise ateşli silah yaralanması nedeniyle başvurdu. Tüm hastalara acil cerrahi yapıldı. Kardiyak yaralanmalar 13 hastada sağ ventrikül, beş hastada sol ventrikül ve bir hastada sağ atriyum şeklinde idi. Hastaların hiçbirinde mortalite izlenmedi. İki hastada kanama nedeniyle revizyon gerekirken, bir hastada yara yeri enfeksiyonu gelişti ve bir diğerinde takip sırasında ventriküler septal defekt tespit edildi.Sonuç: Erken nakil, etkin tanı ve gerektiğinde acil cerrahi ile birlikte tedavi penetran kalp yaralanması olan hastaların sağkalım oranını artırır.

Penetrating cardiac injuries: Review of 19 cases

Background: In this study, we present patients treated surgically in our hospital for a penetrating cardiac injury. Methods: Between August 2001 and October 2016, a total of 19 male patients (mean age 32.7±17.3 years; range, 15 to 73 years) who were admitted to our hospital with a penetrating cardiac injury were retrospectively analyzed. Clinical findings, treatment methods, and treatment outcomes of the patients were recorded. Results: Among all patients, 16 were admitted for a stab injury and three for a gunshot injury. An emergent surgery was performed in all patients. Cardiac injuries involved the right ventricle in 13 patients, left ventricle in five patients, and right atrium in one patient. No mortality was seen in any of the patients. Revision was needed in two patients due to bleeding, while wound site infection developed in one patient and a ventricular septal defect was detected during follow-up in another patient. Conclusion: Early transport, effective diagnosis and treatment with emergent surgery, when required, increase the survival of patients with a penetrating cardiac injury.

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20. Kuriyan M, Carson JL. Blood transfusion risks in the intensive care unit. Crit Care Clin 2004;20:237-53.
19. Hardikar AA, Thakur SS, Karmarkar PS, Ambike VS, Kanetkar AV, Golhar KB. Penetrating cardiac injury due to ball pointpen. Asian Cardiovasc Thorac Ann 1999;7:158-60.
18. Velmahos GC, Degiannis E, Souter I, Saadia R. Penetrating trauma to the heart: a relatively innocent injury. Surgery 1994;115:694-7.
17. Schaff HV, Hauer JM, Bell WR, Gardner TJ, Donahoo JS, Gott VL, et al. Autotransfusion of shed mediastinal blood after cardiac surgery: a prospective study. J Thorac Cardiovasc Surg 1978;75:632-41.
16. Serrano FJ, Moñux G, Aroca M. Should the cell saver autotransfusion system be routinely used in elective aortic surgery? Ann Vasc Surg 2000;14:663-8.
15. O’Connor J, Ditillo M, Scalea T. Penetrating cardiac injury. J R Army Med Corps 2009;155:185-90.
14. Koçak H, Becit N, Unlü Y. A nail in the heart. Ann Thorac Surg 2004;78:15.
13. Reif J, Justice JL, Olsen WR, Prager RL. Selective monitoring of patients with suspected blunt cardiac injury. Ann Thorac Surg 1990;50:530-2.
12. Andrade-Alegre R, Mon L. Subxiphoid pericardial window in the diagnosis of penetrating cardiac trauma. Ann Thorac Surg 1994;58:1139- 41.
11. Meyer DM, Jessen ME, Grayburn PA. Use of echocardiography to detect occult cardiac injury after penetrating thoracic trauma: a prospective study. J Trauma 1995;39:902-7.
10. Kulshrestha P, Das B, Iyer KS, Sampath KA, Sharma ML, Rao IM, et al. Cardiac injuries--a clinical and autopsy profile. J Trauma 1990;30:203-7.
9. Akay T. Kalp ve damar yaralanmaları. TTD Toraks Cerrahisi Bülteni 2010;1;1:75-86.
8. Ivatury RR, Rohman M, Steichen FM, Gunduz Y, Nallathambi M, Stahl WM. Penetrating cardiac injuries: twenty-year experience. Am Surg 1987;53:310-7.
7. Lateef Wani M, Ahangar AG, Wani SN, Irshad I, Ul-Hassan N. Penetrating cardiac injury: a review. Trauma Mon 2012;17:230-2.
6. Arikan S, Yücel AF, Kocakuşak A, Dadük Y, Adaş G, Onal MA. Retrospective analysis of the patients with penetrating cardiac trauma. [Article in Turkish] Ulus Travma Acil Cerrahi Derg 2003;9:124- 8.
5. Moore EE, Mattox KL, Feliciano DV, editors. Trauma. 2nd ed. Norwalk: Appleton & Lange; 1991.
4. Hill LL. Report of a case of successful suture of the heart. Medical Record 1902;29:846.
3. Sugg WL, Rea WJ, Ecker RR, Webb WR, Rose EF, Shaw RR. Penetrating wounds of the heart. An analysis of 459 cases. J Thorac Cardiovasc Surg 1968;56:531-45.
2. Sabiston DC, editor. Textbook of surgery: the biological basis of modern surgical practice. 14th ed. Philadelphia: Saunders; 1991.
1. Erzurumlu K, Türkay B, Kalyoncu A, Guney. M. Penetran kalp yaralanmaları. Turk Gogus Kalp Dama 1994;2:270-3.