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Unusual Manifestations of Penetrating Cardiac Injuries

Unusual Manifestations of Penetrating Cardiac Injuries Abstract • Penetrating cardiac injuries frequently first appear in an unusual and insidious manner, and their diagnosis may not be immediately obvious. In a series of 20 cases of cardiac injury, ten cases were indicative of such subtle symptoms, several of which were life-threatening. These unusual manifestations can be categorized as early, intermediate, or late. Early problems of four patients included the following: (1) sudden onset of shock during laparotomy, performed due to apparent abdominal trauma; (2) cardiac arrest on arrival in the emergency room; and (3) cerebral air embolus that mimicked symptoms of possible irreversible anoxic brain damage. The intermediate manifestations of cardiac injury are usually discovered in the early recovery period, and include myocardial infarction with cardiogenic shock and bullet embolus to a peripheral artery. Intermediate manifestations were observed in two patients. Four patients had late complications that included pseudoaneurysm, ventricular septal defect, valvular damage, and recurrent pericarditis. These late complications were observed between one month and 21 years after cardiac injury. This indicates the necessity of long-term follow-up of these patients. (Arch Surg 110:1357-1362, 1975) References 1. Siegel RE: Galen on surgery of the pericardium: An early record of therapy based on anatomical and experimental studies . Am J Cardiol 26:524-526, 1970.Crossref 2. Spodick DH: Medical history of the pericardium: The hairy hearts of hoary heroes . Am J Cardiol 26:447-454, 1970.Crossref 3. Brewer LA III: Wounds of the chest in war and peace: 1943-1968 . Ann Thorac Surg 7:387-408, 1969.Crossref 4. Larrey DJ: Sur une blessure du pericorde suivie d'hydropericarde . Bull Sci Med 6:1, 1810. 5. Ballance C: The surgery of the heart . Lancet 1:1-5, 1920. 6. Sauerbruch F: Chirurgie der Brustorgane . Berlin, Gottingen, 1925. 7. Symbas PN: Traumatic Injuries of the Heart and Great Vessels . Springfield, Ill, Charles C Thomas Publisher, 1972. 8. Beall AC Jr, Gasior RM, Bricker DL: Gunshot wounds of the heart . Ann Thorac Surg 11:523-531, 1971.Crossref 9. Symbas PN, diOrio DA, Tyras DH, et al: Penetrating cardiac wounds: Significant residual and delayed sequelae . J Thorac Cardiovasc Surg 66:526-532, 1973. 10. Cleveland RJ, Benfield JR, Nemhauser GM, et al: Management of penetrating wounds of the heart . Arch Surg 97:517-520, 1968.Crossref 11. Carrasquilla C, Wilson RF, Walt AJ, et al: Gunshot wounds of the heart . Ann Thorac Surg 13:208-213, 1972.Crossref 12. Hewitt RL, Smith AD Jr, Weichert RF III, et al: Penetrating cardiac injuries: Current trends in management . Arch Surg 101:683-688, 1970.Crossref 13. Anagnostopoulos CE, Kittle CF: Penetrating wounds of the heart and great vessels: A report of 30 patients . Thorax 28:142-146, 1973.Crossref 14. Sugg WL, Rea WJ, Ecker RR, et al: Penetrating wounds of the heart: An analysis of 459 cases . J Thorac Cardiovasc Surg 56:531-543, 1968. 15. Shoemaker WC, Carey JS, Yao ST, et al: Hemodynamic monitoring for physiologic evaluation, diagnosis, and therapy of acute hemopericardial tamponade from penetrating wounds . J Trauma 13:36-44, 1973.Crossref 16. Shabetai R, Fowler NO, Guntheroth WG: The hemodynamics of cardiac tamponade and constrictive pericarditis . Am J Cardiol 26:480-489, 1970.Crossref 17. Beall AC Jr, Patrick TA, Okies JE, et al: Penetrating wounds of the heart: Changing patterns of surgical management . J Trauma 12:468-473, 1972.Crossref 18. Thomas AN, Stephens BG: Air embolism: A cause of morbidity and death after penetrating chest trauma . J Trauma 14:633-638, 1974.Crossref 19. DeMuth WE Jr, Baue AE, Odom JA Jr: Contusions of the heart . J Trauma 7:443-455, 1967.Crossref 20. Rich NM, Manion WC, Hughes CW: Surgical and pathological evaluation of vascular injuries in Vietnam . J Trauma 9:279-291, 1969.Crossref 21. Trimble C: Arterial bullet embolism following thoracic gunshot wounds . Ann Surg 65:911-916, 1968.Crossref 22. Ward PA, Suzuki A: Gunshot wound of the heart with peripheral embolization . J Thorac Cardiovasc Surg 68:400-446, 1974. 23. Reichenbach D, Benditt EP: Myofibrillar degeneration: A common form of cardiac muscle injury . Ann NY Acad Sci 156:164-175, 1969.Crossref 24. Aronstam EM, Strader LD, Geiger JP, et al: Traumatic left ventricular aneurysms . J Thorac Cardiovasc Surg 59:239-242, 1970. 25. Soulen RL, Freeman E: Radiologic evaluation of traumatic heart disease . Radiol Clin North Am 1:285-297, 1971. 26. Fallah-Nejad M, Abelson DM, Blakemore WS: Left ventricular pseudoaneurysm: A rare complication of open-heart surgery with unusual Doppler manifestations . Chest 61:90-92, 1972.Crossref 27. Symbas PN, Ware RE, Belenki I, et al: Traumatic biventricular pseudoaneurysm of the heart with ventricular septal defect . J Thorac Cardiovasc Surg 64:647-651, 1972. 28. Desser KB, Benchimol A, Cornell WP, et al: Traumatic ventricular septal defect, aortic insufficiency, and sinus aneurysm . J Thorac Cardiovasc Surg 62:830-834, 1971. 29. Sinha SN, Bhattacharya SK, Mymin D, et al: Ventricular septal defects due to penetrating injuries of the heart . J Thorac Cardiovasc Surg 69:450-457, 1975. 30. Asfaw I, Thorns NW, Arbulu A: Interventricular septal defects from penetrating injuries of the heart . J Thorac Cardiovasc Surg 69:450-457, 1975. 31. Kay JH, Thomas V, Blalock A: The experimental production of high interventricular septal defects: A physiological and pathological study . Surg Gynecol Obstet 96:529-535, 1953. 32. Pirzada FA, McDowell JW, Cohen EM, et al: Traumatic ventricular septal defect . N Engl J Med 291:892-894, 1974.Crossref 33. DeMuth WE Jr, Fallah-Nejad M: Delayed recognition of thoracic injuries . Am J Surg 111:587-590, 1966.Crossref 34. Levitsky S: New insights in cardiac trauma . Surg Clin North Am 5:43-55, 1975. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1975.01360170097014
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Abstract

Abstract • Penetrating cardiac injuries frequently first appear in an unusual and insidious manner, and their diagnosis may not be immediately obvious. In a series of 20 cases of cardiac injury, ten cases were indicative of such subtle symptoms, several of which were life-threatening. These unusual manifestations can be categorized as early, intermediate, or late. Early problems of four patients included the following: (1) sudden onset of shock during laparotomy, performed due to apparent abdominal trauma; (2) cardiac arrest on arrival in the emergency room; and (3) cerebral air embolus that mimicked symptoms of possible irreversible anoxic brain damage. The intermediate manifestations of cardiac injury are usually discovered in the early recovery period, and include myocardial infarction with cardiogenic shock and bullet embolus to a peripheral artery. Intermediate manifestations were observed in two patients. Four patients had late complications that included pseudoaneurysm, ventricular septal defect, valvular damage, and recurrent pericarditis. These late complications were observed between one month and 21 years after cardiac injury. This indicates the necessity of long-term follow-up of these patients. (Arch Surg 110:1357-1362, 1975) References 1. Siegel RE: Galen on surgery of the pericardium: An early record of therapy based on anatomical and experimental studies . Am J Cardiol 26:524-526, 1970.Crossref 2. Spodick DH: Medical history of the pericardium: The hairy hearts of hoary heroes . Am J Cardiol 26:447-454, 1970.Crossref 3. Brewer LA III: Wounds of the chest in war and peace: 1943-1968 . Ann Thorac Surg 7:387-408, 1969.Crossref 4. Larrey DJ: Sur une blessure du pericorde suivie d'hydropericarde . Bull Sci Med 6:1, 1810. 5. Ballance C: The surgery of the heart . Lancet 1:1-5, 1920. 6. Sauerbruch F: Chirurgie der Brustorgane . Berlin, Gottingen, 1925. 7. Symbas PN: Traumatic Injuries of the Heart and Great Vessels . Springfield, Ill, Charles C Thomas Publisher, 1972. 8. Beall AC Jr, Gasior RM, Bricker DL: Gunshot wounds of the heart . Ann Thorac Surg 11:523-531, 1971.Crossref 9. Symbas PN, diOrio DA, Tyras DH, et al: Penetrating cardiac wounds: Significant residual and delayed sequelae . J Thorac Cardiovasc Surg 66:526-532, 1973. 10. Cleveland RJ, Benfield JR, Nemhauser GM, et al: Management of penetrating wounds of the heart . Arch Surg 97:517-520, 1968.Crossref 11. Carrasquilla C, Wilson RF, Walt AJ, et al: Gunshot wounds of the heart . Ann Thorac Surg 13:208-213, 1972.Crossref 12. Hewitt RL, Smith AD Jr, Weichert RF III, et al: Penetrating cardiac injuries: Current trends in management . Arch Surg 101:683-688, 1970.Crossref 13. Anagnostopoulos CE, Kittle CF: Penetrating wounds of the heart and great vessels: A report of 30 patients . Thorax 28:142-146, 1973.Crossref 14. Sugg WL, Rea WJ, Ecker RR, et al: Penetrating wounds of the heart: An analysis of 459 cases . J Thorac Cardiovasc Surg 56:531-543, 1968. 15. Shoemaker WC, Carey JS, Yao ST, et al: Hemodynamic monitoring for physiologic evaluation, diagnosis, and therapy of acute hemopericardial tamponade from penetrating wounds . J Trauma 13:36-44, 1973.Crossref 16. Shabetai R, Fowler NO, Guntheroth WG: The hemodynamics of cardiac tamponade and constrictive pericarditis . Am J Cardiol 26:480-489, 1970.Crossref 17. Beall AC Jr, Patrick TA, Okies JE, et al: Penetrating wounds of the heart: Changing patterns of surgical management . J Trauma 12:468-473, 1972.Crossref 18. Thomas AN, Stephens BG: Air embolism: A cause of morbidity and death after penetrating chest trauma . J Trauma 14:633-638, 1974.Crossref 19. DeMuth WE Jr, Baue AE, Odom JA Jr: Contusions of the heart . J Trauma 7:443-455, 1967.Crossref 20. Rich NM, Manion WC, Hughes CW: Surgical and pathological evaluation of vascular injuries in Vietnam . J Trauma 9:279-291, 1969.Crossref 21. Trimble C: Arterial bullet embolism following thoracic gunshot wounds . Ann Surg 65:911-916, 1968.Crossref 22. Ward PA, Suzuki A: Gunshot wound of the heart with peripheral embolization . J Thorac Cardiovasc Surg 68:400-446, 1974. 23. Reichenbach D, Benditt EP: Myofibrillar degeneration: A common form of cardiac muscle injury . Ann NY Acad Sci 156:164-175, 1969.Crossref 24. Aronstam EM, Strader LD, Geiger JP, et al: Traumatic left ventricular aneurysms . J Thorac Cardiovasc Surg 59:239-242, 1970. 25. Soulen RL, Freeman E: Radiologic evaluation of traumatic heart disease . Radiol Clin North Am 1:285-297, 1971. 26. Fallah-Nejad M, Abelson DM, Blakemore WS: Left ventricular pseudoaneurysm: A rare complication of open-heart surgery with unusual Doppler manifestations . Chest 61:90-92, 1972.Crossref 27. Symbas PN, Ware RE, Belenki I, et al: Traumatic biventricular pseudoaneurysm of the heart with ventricular septal defect . J Thorac Cardiovasc Surg 64:647-651, 1972. 28. Desser KB, Benchimol A, Cornell WP, et al: Traumatic ventricular septal defect, aortic insufficiency, and sinus aneurysm . J Thorac Cardiovasc Surg 62:830-834, 1971. 29. Sinha SN, Bhattacharya SK, Mymin D, et al: Ventricular septal defects due to penetrating injuries of the heart . J Thorac Cardiovasc Surg 69:450-457, 1975. 30. Asfaw I, Thorns NW, Arbulu A: Interventricular septal defects from penetrating injuries of the heart . J Thorac Cardiovasc Surg 69:450-457, 1975. 31. Kay JH, Thomas V, Blalock A: The experimental production of high interventricular septal defects: A physiological and pathological study . Surg Gynecol Obstet 96:529-535, 1953. 32. Pirzada FA, McDowell JW, Cohen EM, et al: Traumatic ventricular septal defect . N Engl J Med 291:892-894, 1974.Crossref 33. DeMuth WE Jr, Fallah-Nejad M: Delayed recognition of thoracic injuries . Am J Surg 111:587-590, 1966.Crossref 34. Levitsky S: New insights in cardiac trauma . Surg Clin North Am 5:43-55, 1975.

Journal

Archives of SurgeryAmerican Medical Association

Published: Nov 1, 1975

References