PENETRATING INTRAPERICARDIAL WOUNDS - CLINICAL-EXPERIENCE WITH A SURGICAL PROTOCOL

Background. From 1972 to 1977, a treatment protocol was developed at o ur institution for patients with suspected penetrating intrapericardia l wounds. It consists of immediate transport to the operating room, pe ricardial decompression by subxiphoid pericardial window under local o r light general anesthesia in patients in stable condition, and median sternotomy and operative repair with limited use of cardiopulmonary b ypass. Methods. The records of 79 consecutive patients with acute pene trating intrapericardial injury who underwent operation from March 197 8 to July 1991 were reviewed. There were 59 patients (75%) with stab w ounds and 20 (25%) with gunshot wounds. Wound location was as follows: right ventricle, 33 (42%); left ventricle, 28 (35%); multiple sites, 8 (10%); atrium, 5 (6%); and great vessels, 5 (6%). Results. Subxiphoi d pericardial window was performed under local or light general anesth esia in 53 patients (67%). Cardiopulmonary bypass was required in only 4 patients. Overall mortality was 6%. Conclusion. Approach to a traum a victim must be systematic. We believe one treatment protocol for pat ients with suspected penetrating intrapericardial wounds is effective.