Penetran kalp yaralanmalarının tanı ve tedavisi
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Date
1990
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Publisher
Uludağ Üniversitesi
Abstract
Son on yıl içinde kalp yaralanması nedeniyle tedavi edilen 48 olgu arda dönük olarak incelendi. Olguların 45'i erkek, üçü kadındı. Yaralanma 34 olguda delici-kesici aletle, 9 olguda ateşli silahla, 5 olguda künt travmayla oluşmuştu. Kırk sekiz olguda 55 kalp yaralanması vardı. Olguların 25'inde sağ ventrikül, 14'ünde sol ventrikül yaralanmıştı. Olguların dördünde yaralanmaya bağlı intrakardiak şant vardı. İki olguda VSD, bir olguda aorttan sağ ventriküler şant, bir olguda sol.vetfkülden pulmoner artere şant saptandı. Tüm intrakardiak şantlar açık kalp tekniği ile başarılı olarak tedavi edildiler. Kalp yaralanması tanısını destekleyen en önemli bulgu yaralanmanın yeri yanı sıra santral venöz basıncın yüksek olması, paradoks nabız ve hipotansiyon saptanması oldu. Değişik derecede şok ve kalp tamponadı tablosu ile hastaneye başvuran 33 olguda kalp yaralanması belirgin ve olgular hızla ameliyathaneye götürülerek torakotomi yapıldı. Bu olgulardan 8'i kaybedildi. Stabil nornatiransif veya hafif hipotansif durumda olan onbeş olguya ameliyat öncesinde tam klinik muayene ve laboratuvar incelemesi yapıldı. Bu gruptaki olguların hepsi yaşatıldı. Ateşli silah yaralanması ve künt travma geçiren olgularda mortalite, kesici-delici alet yaralanmalarına göre çok yüksek bulundu: İki olgu kontrol edilemeyen kanama ve irreversibl şok nedeniyle ameliyatta, bir olgu miyokard kontüzyonu, bir olgu ise irreversibl beyin ölümü nedeniyle ameliyat sonrası dönemde kaybedildiler. Diğer dört olgunun kaybedilmesinin nedeni karaciğer, beyin ve özofagus gibi diğer organ yaralanmalarıydı.
This retrospective study comprised 48 consecutive cases of penetrating injury of the heart treated in the last ten years. Forty-five of the cases were male and three female. There were 34 stab wounds, 9 gunshot wounds and 5 blunt trauma cases. There were 55 heart injuries in 48 cases. In 25 cases the right ventricle and 14 cases left ventricle was wounded. There were intracardiac shunts in four cases: Two VSD, one aorto-right ventricular and one left ventricular-pulmonary artery fistula. All of the intracardiac shunts were treated successfully with open heart surgery. Most important evidence suggestive of cardiac injury was the presence of precordial wounds with elevated central venous pressure, hypotension and pulsus paradoxus. Thirty-three cases were admitted in varying degrees of shock and cardiac tamponade. In this case the diagnosis of cardiac wound was obvious, patients were transferred to the operating room and urgent thoracotomy was done. Eight cases died in this group. Fifteen cases were admitted in stable, normotensive or mild hypotensive states, all of which survived. This cases were stable enough to undergo some clinical and laboratory examination before operation. There was a consistently higher survival rate among the stab wound cases than the gunshot wounds and bluntırauma cases. Two cases died in operation due to irreversible shock and uncontrollable bleeding. In one case myocardial contusion and in another case irreversible brain injury was the cause of death. In other four cases, major problem of death was the associated trauma, such as liver, brain and esophagus.
This retrospective study comprised 48 consecutive cases of penetrating injury of the heart treated in the last ten years. Forty-five of the cases were male and three female. There were 34 stab wounds, 9 gunshot wounds and 5 blunt trauma cases. There were 55 heart injuries in 48 cases. In 25 cases the right ventricle and 14 cases left ventricle was wounded. There were intracardiac shunts in four cases: Two VSD, one aorto-right ventricular and one left ventricular-pulmonary artery fistula. All of the intracardiac shunts were treated successfully with open heart surgery. Most important evidence suggestive of cardiac injury was the presence of precordial wounds with elevated central venous pressure, hypotension and pulsus paradoxus. Thirty-three cases were admitted in varying degrees of shock and cardiac tamponade. In this case the diagnosis of cardiac wound was obvious, patients were transferred to the operating room and urgent thoracotomy was done. Eight cases died in this group. Fifteen cases were admitted in stable, normotensive or mild hypotensive states, all of which survived. This cases were stable enough to undergo some clinical and laboratory examination before operation. There was a consistently higher survival rate among the stab wound cases than the gunshot wounds and bluntırauma cases. Two cases died in operation due to irreversible shock and uncontrollable bleeding. In one case myocardial contusion and in another case irreversible brain injury was the cause of death. In other four cases, major problem of death was the associated trauma, such as liver, brain and esophagus.
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Keywords
Penetran kalp yaralanmaları, Penetrating heart injuries
Citation
Özkan, H. vd. (1990). ''Penetran kalp yaralanmalarının tanı ve tedavisi''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 17(1), 125-135.