title: High-velocity penetrating thoracic trauma with suspected cardiac involvement in a combat support hospital.
abstract: OBJECTIVE
  The most common cardiac injuries in the United States are blunt trauma from motor vehicle accidents or low-velocity trauma from stabbings. During military conflict, high-velocity injuries, including gunshot wounds (GSW) and fragment injury from improvised explosive devices (IED), are relatively more common.
  
  
  METHODS
  This is a retrospective review of cases with high-velocity penetrating injury and suspected myocardial involvement during a 6-month period in Baghdad, Iraq, at a United States Army hospital during Operation Iraqi Freedom.
  
  
  RESULTS
  Eleven cases survived to admission (GSW in 5, IED in 6). The mean age of the all-male cohort was 27 years (range, 3-54 years). Eight of the 11 patients (73%) were victims of polytrauma. The entrance involved the right ventricle (n = 3), right atrium (n = 2), left ventricle (n = 1), or mediastinum and pericardial reflections (n = 5). Echocardiography was performed in all 11 patients. In 7 patients, no foreign body was identifiable, and in 2 patients the foreign body was identified within the pericardial fat pad. Three patients were identified as having a suspected ventricular septal defect, ranging in size from 2 to 8 mm. The most common electrocardiographic abnormality was atrioventricular block and right bundle branch block. In 4 patients, the management of the chest injury was nonsurgical, and in 1 patient the treatment was a chest tube only. Four of the patients underwent median sternotomy, 1 underwent emergent lateral thoracotomy, and 1 underwent an infradiaphragmatic approach.
  
  
  CONCLUSIONS
  This case series is too small to draw definitive conclusions; however, a multidisciplinary approach to high-velocity injuries with potential for cardiac involvement augments preoperative assessment for myocardial injury and may allow selective nonoperative management.
authors.affiliation: Cardiology Service MCHE-MDC, Brooke Army Medical Center, 3851 Roger Brooke Drive, San Antonio, TX 78234-6200, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Dominguez
authors.forename: Alec C
authors.initials: AC
authors.lastname: Beekley
authors.forename: Linda L
authors.initials: LL
authors.lastname: Huffer
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Gentlesk
authors.forename: Robert E
authors.initials: RE
authors.lastname: Eckart
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000293:injuries / Q000601:surgery*; D054042:Bombs; D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D053834:Explosive Agents / Q000009:adverse effects*; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D010348:Patient Care Team; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
chemical_list: D053834:Explosive Agents