Current evaluation of cardiac stab wounds

Background. Patients with penetrating cardiac injuries may be stable or onl y mildly shocked, especially if the laceration has sealed off and the patie nt has been aggressively resuscitated. Clinical signs, chest roentgenograms , pericardiocentesis, and subxiphoid window are not always helpful in estab lishing the diagnosis. We reflect on the current evaluation based on 128 pa tients. Methods. There were four groups of patients, ranging from lifeless (group I ) to stable (group IV). Patients in groups I and II were prepared immediate ly for operation. Those in groups III and IV were often investigated furthe r (chest roentgenogram and cardiac ultrasound). Results. Mortality was 8%. Significant findings were a precordial stab, cen tral venous pressure of more than 15 cm of water, one or more clinical sign s of tamponade, and initial shock. Cardiac ultrasound was performed in 5 pa tients in group II (15%), 14 patients in group III (48%), and 37 patients i n group IV (86%). There were no false positives, and 6 false negatives (11% ). Thirty-one patients (24%) had clotted lacerations. There were no negativ e sternotomies. Conclusions. Efficient fluid resuscitation and rapid confirmation of diagno sis with cardiac ultrasound should decrease mortality. Stable patients with a precordial wound should undergo cardiac ultrasound or echocardiogram. Di agnosis may be reliably confirmed in these patients whose clinical signs of ten fluctuate (or rapidly deteriorate). (C) 1999 by The Society of Thoracic Surgeons.