The Journal of Thoracic and Cardiovascular Surgery, Vol 76, 83-89, Copyright © 1978 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Wounds traversing two or more cardiac chambers. Case presentation of two survivors and review of the literature
GC Enders, GM Graeber and RA Poirier
A review of the literature on patients who have survived wounds traversing
two or more cardiac chambers is presented and two further cases are
documented. The inital management of the patient should be directed toward
control of hemorrhage or treatment of cardica tamponade or both.
Cardiopulmonary bypass is helpful in repair of many intracardiac defects
but is not absolutely essential for survival. Surface myocardial wounds
should be sutured during the initial procedure to allow for immediate
survival. A subsequent procedure may be indicated to correct intracardiac
defects. Repair of injuries to the mitral and aortic valves should be
directed at an attempt to reconstruct the damaged valve. If this is
impossible, a prosthetic valve should be inserted. Injuries to the
tricuspid and pulmonic valves probably warrant a conservative approach.
Septal defects can be treated easily with Dacron patches or primary suture
closure. Postoperative complications include all of those commonly seen
with thoracic procedures, but infection is less prominent than one would
anticipate, even when prostheses have been implanted. With early,
aggressive management it is anticipated that more survivors of these
serious wounds will be recorded.
