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Case Report
Penetrating right ventricular injury following a single gunshot to the left flank in Iraq: a case report
Zryan Salar Majeed, Yad N. Othman, Razhan K. Ali
J Trauma Inj. 2023;36(3):253-257.   Published online April 19, 2023
DOI: https://doi.org/10.20408/jti.2022.0073
  • 885 View
  • 34 Download
AbstractAbstract PDF
A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.
Summary
Original Articles
Blunt Cardiac Injuries That Require Operative Management: A Single-Center 7-Year Experience
Seung Hwan Lee, Myung Jin Jang, Yang Bin Jeon
J Trauma Inj. 2021;34(4):242-247.   Published online July 14, 2021
DOI: https://doi.org/10.20408/jti.2020.0069
  • 5,662 View
  • 111 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

Blunt cardiac injuries (BCI) have a wide clinical spectrum, ranging from asymptomatic myocardial contusion to cardiac rupture and death. BCIs rarely require surgical intervention, but can be rapidly fatal, requiring prompt evaluation and surgical treatment in some cases. The aim of this study was to identify potential factors associated with in-hospital mortality after surgery in patients with BCI.

Methods

The medical records of 15 patients who had undergone emergency cardiac surgery for BCI between January 2014 and August 2020 were retrospectively reviewed. We included trauma patients older than 18 years admitted to Regional Trauma Center, Gachon University Gil Medical Center during the study period. Clinical and laboratory variables were compared between survivors and non-survivors.

Results

Non-survivors showed a significantly higher Injury Severity Score (p=0.001) and Abbreviated Injury Scale in the chest region (p=0.001) than survivors. American Association for the Surgery of Trauma-Organ Injury Scale Grade V injuries were significantly more common in non-survivors than in survivors (p=0.031). Non-survivors had significantly more preoperative packed red blood cell (PRBC) transfusions (p=0.019) and were significantly more likely to experience preoperative cardiac arrest (p=0.001) than survivors. Initial pH (p=0.010), lactate (p=0.026), and base excess (BE; p=0.026) levels showed significant differences between the two groups.

Conclusions

Initial pH, lactate, BE, ventricular injury, the amount of preoperative PRBC transfusions, and preoperative cardiac arrest were potential predictors of in-hospital mortality.

Summary

Citations

Citations to this article as recorded by  
  • Treatment results of cardiac tamponade due to thoracic trauma at Jeju Regional Trauma Center, Korea: a case series
    Jeong Woo Oh, Minjeong Chae
    Journal of Trauma and Injury.2023; 36(3): 180.     CrossRef
Emergency Surgical Management of Traumatic Cardiac Injury in Single Institution for Three Years
Seok Joo, Dae Sung Ma, Yang Bin Jeon, Sung Youl Hyun
J Trauma Inj. 2017;30(4):166-172.   Published online December 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.4.166
  • 3,187 View
  • 61 Download
AbstractAbstract PDF
Purpose

Thoracic traumas represent 10?15% of all traumas and are responsible for 25% of all trauma mortalities. Traumatic cardiac injury (TCI) is one of the major causes of death in trauma patients, rarely present in living patients who are transferred to the hospital. TCI is a challenge for trauma surgeons as it provides a short therapeutic window and the management is often dictated by the underlying mechanism and hemodynamic status. This study is to describe our experiences about emergency cardiac surgery in TCI.

Methods

This is a retrospective clinical analysis of patients who had undergone emergency cardiac surgery in our trauma center from January 2014 to December 2016. Demographics, physiologic data, mechanism of injuries, the timing of surgical interventions, surgical approaches and outcomes were reviewed.

Results

The number of trauma patients who arrived at our hospital during the study period was 9,501. Among them, 884 had chest injuries, 434 patients were evaluated to have over 3 abbreviated injury scale (AIS) about the chest. Cardiac surgeries were performed in 18 patients, and 13 (72.2%) of them were male. The median age was 47.0 years (quartiles 35.0, 55.3). Eleven patients (61.1%) had penetrating traumas. Prehospital cardiopulmonary resuscitations (CPR) were performed in 4 patients (22.2%). All of them had undergone emergency department thoracotomy (EDT), and they were transferred to the operating room for definitive repair of the cardiac injury, but all of them expired in the intensive care unit. Most commonly performed surgical incision was median sternotomy (n=13, 72.2%). The majority site of injury was right ventricle (n=11, 61.1%). The mortality rate was 22.2% (n=4).

Conclusions

This study suggests that penetrating cardiac injuries are more often than blunt cardiac injury in TCI, and the majority site of injury is right ventricle. Also, it suggests prehospital CPR and EDT are significantly responsible for high mortality in TCI.

Summary
Case Reports
Surgical Removal of Intracardiac Foreign Body Remained after Penetrating Cardiac Injury
Kook Yang Park, Chul Hyun Park, Chang Hyu Choi, Jae Ik Lee, Yang Bin Jeon
J Trauma Inj. 2012;25(4):267-270.
  • 1,042 View
  • 5 Download
AbstractAbstract PDF
A 27 year-old man, who had a penetrating cardiac injury due to a metal fragment was transferred to our hospital. At admission, his vital signs were stable, and his chest film showed a foreign-body-like finding in the heart silhouette. We evaluated the patient with chest computed tomography and echocardiography for further information. Finally, we removed the metal fragment from the left ventricle by using a cardiopulmonary bypass.
Summary
Penetrating Injury to the Left Ventricle from a Fractured Rib Following Blunt Chest Trauma
Tak Hyuk Oh, Sang Cjeol Lee, Deok Heon Lee, Joon Yong Cho
J Trauma Inj. 2014;27(4):192-195.
  • 990 View
  • 4 Download
AbstractAbstract PDF
The perforation of a cardiac chamber by a fractured rib after blunt trauma is a rare event. Here, we report the case of patient who was referred for multiple rib fractures after a fall from a height. The patient was found to have a penetrating cardiac injury which was detected on a computed tomography chest scan. Computed tomography is a useful screening tool for victims of blunt chest trauma. Once cardiac perforation has been confirmed or is highly suspected, it is important to preserve the patient's vital signs until reaching the operating room by minimally manuplating the chest wall and permitting hypotension, which also prevents exsanguinating hemorrhage. For the same reasons, early cardiac tamponade may also improve the patient's survival.
Summary

J Trauma Inj : Journal of Trauma and Injury