Penetrating cardiac wounds: A comparison of different therapeutic methods

Abstract

The management of penetrating wounds of the heart has been controversial. During the last 10 years we have used 3 different therapeutic approaches for the treatment of these wounds and the obtained results comprise this report. From 1964 to 1974 we treated 102 patients, four of whom expired immediately after their arrival to the clinic. The remaining 98 patients were divided into five groups according to their clinical presentation and treatment. Group I, 17 patients (14 with stab and 3 with bullet wound) seen with cardiac tamponade from 1964 to 1967 were treated first with pericardiocentesis and then were operated upon if pericardiocentesis yielded no results or if cardiac tamponade recurred. Fourteen patients recovered and three died, with an overall mortality of 17.5% Group II, 34 patients (23 with stab and 11 with bullet wound) were seen with cardiac tamponade from 1968 to 1971. The patients with stab wound were managed the same as group I patients and those with bullet wound were operated upon immediately. Twenty-nine recovered and 5 died, with an overall mortality of 14.7%. Group III, 20 patients (12 with stab and 8 with bullet wound) were seen with cardiac tamponade from 1972 to 1974. All of them were operated upon immediately and pericardiocentesis was used in this group only to provide time for a safe operation. Nineteen recovered and one died, with an overall mortality of 5%. Group IV, 20 patients (5 with stab and 15 with bullet wound) with massive bleeding, were operated upon immediately. Ten (4 out of the 5 with stab and 6 out of the 15 with bullet wound) recovered, with a mortality rate of 50%. Group V, seven patients were seen throughout the study period without bleeding or cardiac tamponade. Some of them were operated upon electively and others are being followed and all have done well. This study suggests (1) that patients with penetrating wound of the heart and cardiac tamponade or bleeding will derive better results if they are operated upon as soon as possible and if pericardiocentesis is used to provide time for a safe operation and (2) that those with other manifestations should be evaluated and if their lesion is significant, they should be operated upon electively.