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Treatment of 28 stabbed heart wounds in 15 dogs was done with traditional suturing or by means of an adhesive and Surgicel. The combination of Surgicel with adhesive ensured adequate closure of the wound and healing. The method is recommended for the treatment of human heart injuries in certain cases.
One case of non-penetrating injury of the heart is reported. The problem of the causal relation between accident and injury of the heart as well as the problems of the pathophysiological mechanisms of non-penetrating traumatic injury of the heart are discussed. The localisation of the non-penetrating traumatic injury, the volume and the energy of the object causing the injury as well as the preexisting degree of coronary sclerosis is of some importance for the severity of heart damages after non-penetrating traumatic injuries of the heart.
The authors had 110 patients with heart injuries (HI) under observation. The blood loss was, 1,092 +/- 120 ml in isolated HI and 2,410 +/- 246 ml in combined HI. Blood reinfusion (BR) was performed during 91 operations, the average volume was 1,233 +/- 215 ml. The peculiarities of reinfusion techniques are analysed and its advantages and shortcomings are critically appraised. The causes of fatal outcomes are shown according to the character of the heart damage and the volumes of blood loss and reinfusion. Mortality in HI with the use of BR was 16.5%.
Basing on the experience of treatment of 23 patients the authors emphasize the importance of rendering the correct urgent aid to patients with such injuries. Cases of injuries of "dangerous zones" of the heart are analyzed. Postoperative complications in such patients are described. The conclusion is made that the time is a decisive factor in decreasing the mortality rate of patients with heart injuries.
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Isolated rat heart was perfused with 18 microM doxorubicin in the recirculating buffer. This treatment resulted in progressive contractile impairment. Aortic flow and minute work (i.e the product of cardiac output and peak systolic pressure) were reduced up to 20 and 29% of basal values, respectively. These parameters were partially restored in hearts perfused with 400 microM spermine, a naturally occurring polyamine, and 18 microM doxorubicin in the recirculating buffer. The results suggest the need for an investigation of the possible antagonistic role of polyamines against anthracycline cardiotoxicity.
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The clinical manifestation of wounds of the heart is determined by the mode, site and size of the injury as well as the structure of the pericardial and myocardial lesion. Diagnosis can be confirmed by ECG and echocardiography. Only 20% of the patients with penetrating wounds of the heart live for more than 30 minutes. Pericardio-centesis should be used only to gain time for a safe sternotomy, cardiac decompression and suture of the wound of the heart. An aggressive surgical approach is mandatory. Cardiopulmonary bypass is necessary only to correct of concomitant lesions.
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