• J Trauma · Jun 1995

    Role of echocardiography in the diagnosis of occult penetrating cardiac injury.

    • K K Nagy, C Lohmann, D O Kim, and J Barrett.
    • Department of Trauma, Cook County Hospital, Chicago, Illinois 60612, USA.
    • J Trauma. 1995 Jun 1; 38 (6): 859-62.

    ObjectiveTo determine the usefulness of early echocardiography in stable patients with penetrating wounds in proximity to the heart.DesignRetrospective chart review over a 1-year period.SettingUrban level I trauma center.Patients121 clinically stable patients with penetrating wounds in proximity to the heart underwent immediate echocardiography (ECHO). Those with evidence of pericardial effusion then underwent subxiphoid pericardial window (SPW), followed by a median sternotomy if blood was found.ResultsThirty patients had an ECHO that was positive and underwent immediate SPW. One patient with an initially negative ECHO deteriorated 5 hours after admission; a repeat ECHO was positive, and he also underwent SPW. In 16 of the 31 SPW performed, blood in the pericardial sac was confirmed. Of these 16, four had pericardial blood that cleared with irrigation and required no further intervention. The remaining 12 patients underwent exploration: 3 had injury to the pericardium only, 4 had injury to the right atrium, 3 had injury to the right ventricle, and 2 had injury to the left ventricle. All nine myocardial injuries required operative repair; all survived.ConclusionsUsing the protocol of early ECHO and selective pericardial window, no clinically significant injuries were missed. In all, 12 penetrating cardiac injuries were identified and repaired successfully. We have found early and aggressive work-up, as outlined herein, to be helpful in the successful treatment of occult cardiac injuries.

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