• Victor Y Kong, George Oosthuizen, Benn Sartorius, John Bruce, and Damian L Clarke.
• Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa. Electronic address: victorywkong@yahoo.com.
• J. Surg. Res. 2015 Feb 1; 193 (2): 926-32.

BackgroundPenetrating cardiac injuries carry a significant mortality, especially if operative intervention is delayed because of diagnostic difficulties.Methods And MaterialsWe reviewed our experience of 134 consecutive cases over a 6 year period. For the initial 5 years, the diagnosis was based on clinical grounds only. During the final year of study, focused ultrasound focused abdominal sonar for trauma (FAST) and subxiphoid pericardial window were introduced.ResultsNinety-six per cent (128/134) were males and the overall mean age was 27 y. Eighty-four per cent (112/134) sustained isolated cardiac injury and the remaining sixteen per cent (22/134) had concurrent injuries elsewhere. A total of 10 FAST's were performed and the sensitivity was 20%. Fifteen subxiphoid pericardial window were performed (8 had diagnostic uncertainty, 2 with double jeopardy, and 5 with delayed tamponade) and had a sensitivity of 100%. The survival rate for the 109 patients from the pre-adjunct period was 83% and 88% for the 25 patients in the post-adjunct period, which was not statistically significant (P value = 0.765). There was no significant difference in the complication rate, mean intensive care unit stay, or mean total hospital stay.ConclusionsPenetrating cardiac injuries are highly lethal. A high index of suspicion, coupled with early operative intervention remains the key in securing the survival of these patients.Copyright © 2015 Elsevier Inc. All rights reserved.

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