Authors
Lischuk A.N.1, Moshkin S.V.2, Plahotnikov I.A.2, Zalyubovskaya L.V.* 2, Havandeev M.L.1, Gitelzon E.A.3, Faibushevich A.G.3
1 National Medical Research Center of High Medical Technologies — the Central Military Clinical Hospital of A.A. Vishnevsky, Krasnogorsk
2 Donetsk’ Clinical Territorial Medical Association, Donetsk, Donetsk People’s Republic
3 RUDN University, Moscow
Abstract
In peacetime the frequency of heart wounds with penetrating chest wounds in admitted patients ranges from 5% to 16%, mainly with cutting objects. During local hostilities the frequency of heart injuries by foreign bodies increases, despite the presence of personal protective equipment.
Material and methods. A retrospective analysis of 54 case histories of patients with heart and pericardium injury who were operated from 2022 to 2023 years (52 men and 2 women, the average age was 35.7±7.4).
Results. The localization of a foreign body after pericardiotomy was as follows: in the right ventricle — 20 cases, left ventricle — 16, right atrium — 2, interventricular septum — 1, in the lumen of the pulmonary artery — 1, pericardium- 13, aortic window — 1.
2 patients were operated videothoracoscopically, 19 had an anterolateral thoracotomy and 33 had sternotomy (16 of which were operated under conditions of cardio-pulmonary bypass).
Conclusions. Hemodynamically stable patients need to perform X-ray and СТ scan of the chest urgently, and in order to make a decision on the need for cardio-pulmonary bypass — coronaroventriculography, aortography and/or angiopulmonography. Emergency anterolateral thoracotomy is indicated for all hemodynamically unstable patients. If a foreign body is detected in the chambers of the heart or intimately adjacent to the main vessels, it is necessary to perform a sternotomy to be able to quickly connect to cardio-pulmonary bypass. Surgical treatment with the use of cardio-pulmonary bypass is the only way out in particularly difficult cases of damage to the heart by foreign bodies. In the absence of a foreign body in the pericardium or epicardium, it is necessary to use a C-arc to search for it. The mortality rate for blind shraonel wounds of the heart and pericardium was 3.7%.
Keywords: heart lesion, foreign body, mine explosion injury, cardio-pulmonary bypass.
References
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