title: Wounds traversing two or more cardiac chambers. Case presentation of two survivors and review of the literature.
abstract: A review of the literature on patients who have survived wounds traversing two or more cardiac chambers is presented and two further cases are documented. The inital management of the patient should be directed toward control of hemorrhage or treatment of cardica tamponade or both. Cardiopulmonary bypass is helpful in repair of many intracardiac defects but is not absolutely essential for survival. Surface myocardial wounds should be sutured during the initial procedure to allow for immediate survival. A subsequent procedure may be indicated to correct intracardiac defects. Repair of injuries to the mitral and aortic valves should be directed at an attempt to reconstruct the damaged valve. If this is impossible, a prosthetic valve should be inserted. Injuries to the tricuspid and pulmonic valves probably warrant a conservative approach. Septal defects can be treated easily with Dacron patches or primary suture closure. Postoperative complications include all of those commonly seen with thoracic procedures, but infection is less prominent than one would anticipate, even when prostheses have been implanted. With early, aggressive management it is anticipated that more survivors of these serious wounds will be recorded.
mesh_terms: D000293:Adolescent; D006323:Heart Arrest / Q000209:etiology; D006325:Heart Atria / Q000293:injuries*; D006335:Heart Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006346:Heart Septum / Q000293:injuries; D006352:Heart Ventricles / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000293:injuries; D010490:Pericardial Effusion / Q000209:etiology; D014261:Tricuspid Valve / Q000293:injuries; D014948:Wounds, Gunshot / Q000150:complications / Q000601:surgery*