Solving the impossible. Penetrating cardiac injuries, a case series of diagnostic workup and management

Solving the impossible. Penetrating cardiac injuries, a case series of diagnostic workup and management

Main Article Content

Hector Vergara-Miranda https://orcid.org/0000-0001-7419-1311
Luis Adrian Alvarez-Lozada https://orcid.org/0000-0002-7010-5698
Josefina Belem Leyva-Alamillo https://orcid.org/0000-0001-8301-7083
Raúl Omar Martínez-Zarazua https://orcid.org/0000-0001-8387-2637
Lourdes Paola Chapa-Montalvo https://orcid.org/0000-0003-1925-4812
Luis Rodrigo Gómez-Alvarez https://orcid.org/0000-0001-9917-3953

Abstract

For a long time, any heart-based injury was an off-limits area for surgeons; a patient with a traumatic cardiac injury was doomed to die. Little more than one hundred years have passed since the first surgical correction of a penetrating cardiac injury and there is still a high rate of mortality, despite the medical advances. We present the case of 6 patients with penetrating cardiac injuries that were repaired at a third level hospital of Mexico, alongside relevant findings on the literature about the topic. From 2019 to 2020, an incidence of 6 patients with penetrating cardiac injuries was present; all men aged 30 years or older. The etiology of 4 (67%) patients was stab wounds and 2 (33%) gunshot wounds. Left anterolateral thoracotomy was used on 5 (83%) patients and midline sternotomy on 1 (17%) patient. 2 (33%) injuries on the left ventricle presented along with coronary arteries injuries. Left ventricle and right atrium injuries presented each 50% of mortality. The mortality was of 33%, 1 patient died due to intraoperative complications and another one due to massive cerebral infarction and polyuric syndrome because of diabetes insipidus. There is a long path ahead of the surgical field on this topic and further to be analyzed. An excellent tool for cardiac tamponade diagnosis due to penetrating cardiac injuries is cardiac ultrasound, therefore it should be used on every hemodynamic unstable patient in the context of PCI. Definitively, time is of the essence, and the survival of patients depends on immediate transport to a hospital and an opportune surgical intervention.

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