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Diagnostic Pericardial Window: A Safe Alternative to Exploratory Thoracotomy for Suspected Heart Injuries

Diagnostic Pericardial Window: A Safe Alternative to Exploratory Thoracotomy for Suspected Heart... Abstract • During a five-year period, 104 patients underwent a pericardial window procedure to diagnose possible cardiac injury. Eighty-eight procedures were performed by a subxiphoid approach, and 16 were transdiaphragmatic in combination with an exploratory laparotomy. There were 51 patients with stab wounds, 45 with gunshot wounds, and eight with blunt trauma. All penetrating wounds were near the heart. In seven patients the window disclosed cardiac damage with no clinical signs of tamponade or shock. Fifty-one patients had signs of tamponade; however, only 12 of them had a cardiac injury diagnosed by pericardial window. Nineteen patients had cardiac injuries. One examination had false-negative results and one study had false-positive results. Cardiac wounds repaired included the right ventricle (eight), left ventricle (three), right atrium (five), and cardiac vein or pericardial wounds (three). Complications were negligible and consisted of minor wound infections (two) and postpericardiotomy syndromes (two). The pericardial window provides a rapid and safe means of diagnosing cardiac injuries in patients with equivocal signs of heart injury while sparing the patient without a heart wound a major operation. (Arch Surg 1987;122:605-609) References 1. Garrison RN, Richardson JD, Fry DE: Diagnostic transdiaphragmatic pericardiotomy in thoracoabdominal trauma . J Trauma 1982;22:147-149.Crossref 2. Peck CH: Operative treatment of heart wounds . Ann Surg 1909;50: 100-105.Crossref 3. Griswold RA, Mcguire CH: Penetrating wounds of the heart and pericardium . Surg Gynecol Obstet 1942;74:406-418. 4. Blalock A, Ravitch MM: Consideration of nonoperative treatment of cardiac tamponade resulting from wounds of the heart . Surgery 1943;14: 157-162. 5. Beall AC, Ochsner FT, Movis GC, et al: Penetrating wounds of the heart . J Trauma 1961;1:195-204.Crossref 6. Sugg WT, Rea WJ, Ecker RR, et al: Penetrating wounds of the heart . J Thorac Cardiovasc Surg 1968;56:531-545. 7. Beall AC, Patrick TA, Okies JE, et al: Penetrating wounds of the heart: Changing patterns of surgical management . J Trauma 1972;12:468-473.Crossref 8. Evans J, Gray LA, Rayner A, et al: Principles for the management of penetrating cardiac wounds . Ann Surg 1979;189:777-784.Crossref 9. Trinkle JK, Toon RS, Franz JL, et al: Affairs of the wounded heart: Penetrating cardiac wounds . J Trauma 1979;19:467-472.Crossref 10. Bodine BI, Smith JP, Blaisdell FW: The role of emergency thoracotomy in blunt trauma . J Trauma 1982;22:487-491.Crossref 11. Washington B, Wilson RF, Steiger B, et al: Emergency thoracotomy: A four-year review . Ann Thorac Surg 1985;40:188-191.Crossref 12. Arom KV, Richardson JD, Webb G, et al: Subxiphoid pericardial window in patients with suspected traumatic pericardial tamponade . Ann Thorac Surg 1977;23:545-549.Crossref 13. Williams JB, Silver DG, Laws HL: Successful management of heart rupture from blunt trauma . Trauma 1981;21:534-537.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Diagnostic Pericardial Window: A Safe Alternative to Exploratory Thoracotomy for Suspected Heart Injuries

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References (16)

Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1987.01400170111016
Publisher site
See Article on Publisher Site

Abstract

Abstract • During a five-year period, 104 patients underwent a pericardial window procedure to diagnose possible cardiac injury. Eighty-eight procedures were performed by a subxiphoid approach, and 16 were transdiaphragmatic in combination with an exploratory laparotomy. There were 51 patients with stab wounds, 45 with gunshot wounds, and eight with blunt trauma. All penetrating wounds were near the heart. In seven patients the window disclosed cardiac damage with no clinical signs of tamponade or shock. Fifty-one patients had signs of tamponade; however, only 12 of them had a cardiac injury diagnosed by pericardial window. Nineteen patients had cardiac injuries. One examination had false-negative results and one study had false-positive results. Cardiac wounds repaired included the right ventricle (eight), left ventricle (three), right atrium (five), and cardiac vein or pericardial wounds (three). Complications were negligible and consisted of minor wound infections (two) and postpericardiotomy syndromes (two). The pericardial window provides a rapid and safe means of diagnosing cardiac injuries in patients with equivocal signs of heart injury while sparing the patient without a heart wound a major operation. (Arch Surg 1987;122:605-609) References 1. Garrison RN, Richardson JD, Fry DE: Diagnostic transdiaphragmatic pericardiotomy in thoracoabdominal trauma . J Trauma 1982;22:147-149.Crossref 2. Peck CH: Operative treatment of heart wounds . Ann Surg 1909;50: 100-105.Crossref 3. Griswold RA, Mcguire CH: Penetrating wounds of the heart and pericardium . Surg Gynecol Obstet 1942;74:406-418. 4. Blalock A, Ravitch MM: Consideration of nonoperative treatment of cardiac tamponade resulting from wounds of the heart . Surgery 1943;14: 157-162. 5. Beall AC, Ochsner FT, Movis GC, et al: Penetrating wounds of the heart . J Trauma 1961;1:195-204.Crossref 6. Sugg WT, Rea WJ, Ecker RR, et al: Penetrating wounds of the heart . J Thorac Cardiovasc Surg 1968;56:531-545. 7. Beall AC, Patrick TA, Okies JE, et al: Penetrating wounds of the heart: Changing patterns of surgical management . J Trauma 1972;12:468-473.Crossref 8. Evans J, Gray LA, Rayner A, et al: Principles for the management of penetrating cardiac wounds . Ann Surg 1979;189:777-784.Crossref 9. Trinkle JK, Toon RS, Franz JL, et al: Affairs of the wounded heart: Penetrating cardiac wounds . J Trauma 1979;19:467-472.Crossref 10. Bodine BI, Smith JP, Blaisdell FW: The role of emergency thoracotomy in blunt trauma . J Trauma 1982;22:487-491.Crossref 11. Washington B, Wilson RF, Steiger B, et al: Emergency thoracotomy: A four-year review . Ann Thorac Surg 1985;40:188-191.Crossref 12. Arom KV, Richardson JD, Webb G, et al: Subxiphoid pericardial window in patients with suspected traumatic pericardial tamponade . Ann Thorac Surg 1977;23:545-549.Crossref 13. Williams JB, Silver DG, Laws HL: Successful management of heart rupture from blunt trauma . Trauma 1981;21:534-537.Crossref

Journal

Archives of Surgery – American Medical Association

Published: May 1, 1987

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