Cardiac Injury due to Thoracic Trauma

Kim, Han Yong; Kim, Myoung Young; Park, Jae Hong; Chei, Chang Seck; Hwang, Sang Won

Abstract

BACKGROUND: Cardiac injuries are the most commonly overlooked injuries in patients who die from trauma. Patients who survive blunt cardiac rupture or penetrating injuries are rare and the incidence is not well defined. Many patients require urgent or emergency operations and operative mortality is very high. MATERIAL AND METHOD: A retrospective review of 26 patients with cardiac injuries due to thoracic trauma undergoing emergency thoracotomy from January 1997 to December 2005. RESULT: There were 17 male and 9 female patients, with a mean age of 45.3+/-16.2 (range: 17~80). Thirteen patients (50%) were injured in motor vehicle accidents, and five patients (19%) in motorcycle accidents. Six patients (23%) were injured by knives, and two patients (8%) were injured by falling. Anatomic injuries included right atrium (12 [46%]), left atrium (1 [4%]), right ventricle (5 [19%]), left ventricle (5 [19%]), and cardiac chambers (2 [7%]). Diagnosis was made by computer tomography in 12 patients and sonography in 14 patients. The average times from admission to operating room was 89.2+/-86.7 min (range: 10~335). The average time for diagnosis was 51.3+/-13.6 min (range: 5~280). The mean Revised Trauma Score (RTS) was 6.7+/-0.8, and the Glasgow Coma Scale (GCS), was 12.8+/-2.8. The overall mortality rate was 12% (3 out of 26 patients).
CONCLUSION
The mortality rate from cardiac injury is very high. The survival rate can be increased only by a high index of suspicion, aggressive expeditious diagnostic evaluation, and prompt appropriate surgical management.