Fatal traumatic heart wounds: review of 160 autopsy cases

2013

Background: Penetrating cardiac injuries are a dramatic and lethal form of trauma. They are usually sustained by young people. The majority of victims die before reaching the hospital. Aim of the study: The aim of the study was to establish prognostic criteria for the outcome of penetrating cardiac injury. Material and methods: We retrospectively reviewed the records of 186 patients with penetrating cardiac injuries who were operated on during the first 24 hours after admission. Results: The mean age was 33 (interquartile range (IQR): 26-44) years. 88.7% of victims were male. The mean time from the moment of trauma to arrival at the hospital in Vilnius city was 60 minutes (IQR: 50-91), whereas from the Vilnius region it was 240 (IQR: 82-390) minutes. The vast majority of patients (176/186, 94.6%) sustained stab wounds. Hemopericardium or cardiac tamponade (142/186, 76.3%) usually was found at the operation. Right ventricle was the most often injured heart chamber (75/186, 40.3%). As...

2005

To present our experience with penetrating cardiac injuries. We have retrospectively reviewed the records of 70 victims of penetrating cardiac injuries. A logistic regression has been performed in order to determine the association between death and clinical predictors. Penetrating injuries consisted of 43 stab wounds (61.4%) and 27 (38.6%) gunshot injuries (Ps0.72). There were 63 (90%) male and 7 female (10%, P-0.001) victims. The mean age was 27.36"11.51, ranging from 3 to 65 years. The overall mortality was 32.9%, 47.8% for gunshot wounds and 52.2% for stab wounds (Ps0.266). Eight victims (11.4%) had associated intra-thoracic great vessel injuries and 17 (24.3%) presented associated intra-abdominal organ injuries. The incidence of injured chamber was: right ventricle 37.1%, right atrium 27.1%, left ventricle 25.7%, and left atrium 5.7%. Non-survivors had lower systolic blood pressure (37.50"39.18 mmHg) than survivors (79.04"41.04 mmHg; P-0.001) upon arrival at the hospital. Thirteen non-survival (56.5%) and 10 (21.3%) survival victims had systolic blood pressure (SBP) F50 mmHg (Ps0.001). The level of systolic blood pressure (SBPF50 mmHg) and consciousness upon arrival at the hospital are predictors of outcome in victims of penetrating cardiac injuries.

Frontiers in Bioscience-Landmark, 2022

Penetrating cardiac injuries represent an increasingly frequent type of trauma in clinical and autopsy practice. The present study aims to review the specialist literature of the last decade (2010-2020) to assess whether the main features of these lesions have changed compared to previous years. The following characteristics were considered: sex, age, cardiac structure involved, execution or not of surgery and postoperative survival, hemodynamic stability, circumstances and mechanism of production, injury and cause of death. Furthermore, the authors propose a practical appraisal of penetrating heart injury in which death was due to a delay in rescue. In line with the data obtained from the practical case, the review showed that compared to the past, the differences concern especially the mortality rate. This paper highlights that the forensic pathologist who approaches a case of transcardiac injury must consider that the circumstances of death are not always attributable to accidental events, attacks or suicides, but may also be due to clinical malpractice or failure to rescue.

Journal of forensic …, 2010

Nonpenetrating chest trauma with injury to the heart and aorta has become increasingly common, particularly as a result of rapid deceleration in high-speed vehicular accidents, over the past 2-3 decades. The high mortality rate of cardiac injuries and possible late onset complications make blunt cardiac injuries an important challenging point for legal medicine. One hundred and ninety cases with blunt cardiac injuries in a period of 3 years were analyzed retrospectively in terms of patterns of cardiac injury, survival times, and demographic profiles of the cases in this study.

The Journal of Trauma: Injury, Infection, and Critical Care, 2009

Objective: The objective of this study was to analyze autopsy findings after blunt traumatic deaths to identify the incidence of cardiac injuries and describe the patterns of associated injuries. Methods: All autopsies performed by the Los Angeles County Forensic Medicine Division for blunt traumatic deaths in 2005 were retrospectively reviewed. Only cases that underwent a full autopsy including internal examination were included in the analysis. The study population was divided into two groups according to the presence or absence of a cardiac injury and compared for differences in baseline characteristics and types of associated injuries. Results: Of the 881 fatal victims of blunt trauma received by the Los Angeles County Forensic Medicine Division, 304 (35%) underwent a full autopsy with internal examination and were included in the analysis. The mean age was 43 years Ϯ 21 years, patients were more often men (71%) and were intoxicated in 39% of the cases. The most common mechanism was motor vehicle collision (50%), followed by pedestrian struck by auto (37%), and 32% had a cardiac injury. Death at the scene was significantly more common in patients with a cardiac injury (78% vs. 65%, p ϭ 0.02). The right chambers were the most frequently injured (30%, right atrium; 27%, right ventricle). Among the 96 patients with cardiac injuries, 64% had transmural rupture. Multiple chambers were ruptured in 26%, the right atrium in 25%, and the right ventricle in 20% of these patients. Patients with cardiac injuries were significantly more likely to have other associated injuries: thoracic aorta (47% vs. 27%, p ϭ 0.001), hemothorax (81% vs. 59%, p Ͻ 0.001), rib fractures (91% vs. 71%, p Ͻ 0.001), sternum fracture (32% vs. 13%, p Ͻ 0.001), and intra-abdominal injury (77% vs. 48%, p Ͻ 0.001) compared with patients without cardiac injury. Of the 96 patients with a cardiac injury, 78% died at the scene of the crash and 22% died en route or at the hospital. Conclusion: Cardiac injury is a common autopsy finding after blunt traumatic fatalities, with the majority of deaths occurring at the scene. Patients with cardiac injuries are at significantly increased risk for associated thoracic and intra-abdominal injuries.

Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2010

Our aim was to express the importance of emergency diagnosis and surgical approach in penetrating cardiac trauma patients. Koşuyolu Heart and Research Hospital moved to its new location in Cevizli Kartal in June 2005. Due to its close proximity to the main roads of the city, the number of trauma cases has increased tremendously. We have retrospectively examined our penetrating cardiac trauma cases treated between June 2005 and September 2008. Twenty-six trauma cases were admitted to our clinic with penetrating cardiac trauma. Twenty of them were operated on an emergency basis. One (5%) had a gunshot wound while the other 19 (95%) had stab wounds. Four were female (20%) and 16 were male (80%). Average age of the patients was 24.9+/-10.1 (12-49) years. Telecardiography and transthoracic echocardiography were used for diagnosis. Surgical approaches were median sternotomy in 14 and left anterolateral thoracotomy in 6 cases. The right ventricle was damaged in 12, left ventricle in 7 and ...

Penetrating cardiac trauma with cardiac exposure and right ventricle laceration due to a domestic accident: case report (Atena Editora), 2023

Introduction: Traumatic causes are among the main causes of morbidity and mortality in the world, especially in people under 45 years of age. This is even more visible in Brazil and Amazonas, with approximately one third of deaths in this age group occurring from traumatic etiologies. Among these, cardiac trauma presents a dramatic situation with high mortality, generally arising from violent causes or automobile accidents. We present a case of cardiac trauma resulting from a domestic accident with a plate causing right ventricle laceration and cardiac exposure. Report of case: A previously healthy 49-year-old woman was transferred to a tertiary hospital after falling over a plate, which generated a linear blunt wound measuring approximately 7cm at the level of the sixth left intercostal space, parallel to the rib, generating cardiac exposure. She had multiple emetic episodes and dyspnea, and closed chest drainage was performed upon admission, maintaining hemodynamic stability with permissive hypotension. She was approached with thoracotomy extending the wound she already had, with pericardiotomy revealing hemopericardium and a laceration in the right ventricle next to the anterior interventricular artery. After digital tamponade, a Foley catheter with traction was used to maintain hemostasis until cardiorrhaphy was performed. She was discharged after 6 days of hospitalization without any functional deficit. Conclusion: Although very uncommon, other cases of accidents with objects that can become sharp have been reported and teams in trauma centers are subject to this. We report a case with good recovery following the same principles as treatment for stab wounds.

Turkish Journal of Trauma and Emergency Surgery, 2011

Penetran kalp yaralanmaları nadirdir ancak yüksek mortalite gösterir. Yaralanmalarda erken tanı ve hızlı müdahale gereklidir. Penetran kalp yaralanması ile görülen hastaların karakteristikleri ve bir eğitim hastanesinde acil hizmeti veren genel cerrahların bireysel tecrübeleri dahil bu hastalarda sağkalımı etkileyen faktörler irdelendi.

Journal of The American College of Surgeons, 1998

Study Design: This is a prospective, 1-year study in a Level I Trauma Center with the objective of analyzing:

International Journal of Health Science, 2023

Traumatic causes are among the main causes of morbidity and mortality in the world, especially in people under 45 years of age. This is even more visible in Brazil and Amazonas, with approximately one third of deaths in this age group occurring from traumatic etiologies. Among these, cardiac trauma presents a dramatic situation with high mortality, generally arising from violent causes or automobile accidents. We present a case of cardiac trauma resulting from a domestic accident with a plate causing right ventricle laceration and cardiac exposure. Report of case: A previously healthy 49-yearold woman was transferred to a tertiary hospital after falling over a plate, which generated a linear blunt wound measuring approximately 7cm at the level of the sixth left intercostal space, parallel to the rib, generating cardiac exposure. She had multiple emetic episodes and dyspnea, and closed chest drainage was performed upon admission, maintaining hemodynamic stability with permissive hypotension. She was approached with thoracotomy extending the wound she already had, with pericardiotomy revealing hemopericardium and a laceration in the right ventricle next to the anterior interventricular artery. After digital tamponade, a Foley catheter with traction was used to maintain hemostasis until cardiorrhaphy was performed. She was discharged after 6 days of hospitalization without any functional deficit. Conclusion: Although very uncommon, other cases of accidents with objects that can become sharp have been reported and teams in trauma centers are subject to this. We report a case with good recovery following the same principles as treatment for stab wounds.