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Ann Thorac Surg 1999;68:2119-2122
© 1999 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Current evaluation of cardiac stab wounds

^a Department of Cardiothoracic Surgery, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa

Address reprint requests to Dr Harris, Department of Cardiothoracic Surgery, Tygerberg Hospital, Suite A2, Cape Town, 7505, South Africa
e-mail: dharris{at}maties.sun.ac.za

Background. Patients with penetrating cardiac injuries may be stable or only mildly shocked, especially if the laceration has sealed off and the patient has been aggressively resuscitated. Clinical signs, chest roentgenograms, pericardiocentesis, and subxiphoid window are not always helpful in establishing the diagnosis. We reflect on the current evaluation based on 128 patients.

Methods. There were four groups of patients, ranging from lifeless (group I) to stable (group IV). Patients in groups I and II were prepared immediately for operation. Those in groups III and IV were often investigated further (chest roentgenogram and cardiac ultrasound).

Results. Mortality was 8%. Significant findings were a precordial stab, central venous pressure of more than 15 cm of water, one or more clinical signs of tamponade, and initial shock. Cardiac ultrasound was performed in 5 patients in group II (15%), 14 patients in group III (48%), and 37 patients in group IV (86%). There were no false positives, and 6 false negatives (11%). Thirty-one patients (24%) had clotted lacerations. There were no negative sternotomies.

Conclusions. Efficient fluid resuscitation and rapid confirmation of diagnosis with cardiac ultrasound should decrease mortality. Stable patients with a precordial wound should undergo cardiac ultrasound or echocardiogram. Diagnosis may be reliably confirmed in these patients whose clinical signs often fluctuate (or rapidly deteriorate).

This article has been cited by other articles:

				A. N. Patel, C. Brennig, J. Cotner, M. A. Lovitt, M. L. Foreman, R. E. Wood, and H. C. Urschel Jr Successful diagnosis of penetrating cardiac injury using surgeon-performed sonography Ann. Thorac. Surg., December 1, 2003; 76(6): 2043 - 2047. [Abstract] [Full Text] [PDF]

				D. G. Harris, J. T. Janson, J. Van Wyk, J. Pretorius, and G. J. Rossouw Delayed pericardial effusion following stab wounds to the chest Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 473 - 476. [Abstract] [Full Text] [PDF]