ROLE OF ECHOCARDIOGRAPHY IN THE DIAGNOSIS OF OCCULT PENETRATING CARDIAC INJURY

Objective: To determine the usefulness of early echocardiography in st able patients with penetrating wounds in proximity to the heart. Desig n: Retrospective chart review over a 1-year period. Setting: Urban lev el I trauma center. Patients: 121 clinically stable patients with pene trating wounds in proximity to the heart underwent immediate echocardi ography (ECHO). Those with evidence of pericardial effusion then under went subxiphoid pericardial window (SPW), followed by a median sternot omy if blood was found. Results: Thirty patients had an ECHO that was positive and underwent immediate SPW. One patient with an initially ne gative ECHO deteriorated 5 hours after admission; a repeat ECHO was po sitive, and he also underwent SPW, In 16 of the 31 SPW performed, bloo d in the pericardial sac was confirmed. Of these 16, four had pericard ial blood that cleared with irrigation and required no further interve ntion. The remaining 12 patients underwent exploration: 3 had injury t o the pericardium only, 4 had injury to the right atrium, 3 had injury to the right ventricle, and 2 had injury to the left ventricle. All n ine myocardial injuries required operative repair; all survived. Concl usions: Using the protocol of early ECHO and selective pericardial win dow, no clinically significant injuries were missed. In all, 12 penetr ating cardiac injuries were identified and repaired successfully. We h ave found early and aggressive work-up, as outlined herein, to be help ful in the successful treatment of occult cardiac injuries.