Secondary Lesions of Penetrating Cardiac Injuries: A Frequent Complication

Between July 1962 and July 1978, 29 patients (23 male and 6 female) from 17 to 48 years of age were followed from two weeks to 15 years after penetrating cardiac injuries involving right ventricle (12), right atrium (6), left ventricle (8), left atrium (2), and pulmonary conus (1). Thoracotomies were performed on all patients either in the emergency room during resuscitation or in the operating room. Repair of the injuries were carried out. All patients were followed for presence of residual cardiac damage. To our surprise, secondary complications were noted in 15 of the 29 patients as follows: Coronary damage (3), pseudoaneurysm (2), bullet embolus (1), VSD (4), recurrent pericarditis (1), mitral valve injury (2), aorta caval (1), and aorto pulmonary fistula (1). Between July 1962 and July 1974, only symptomatic patients with subjective and objective findings had detailed cardiac evaluations. Eight of 20 patients were found to have secondary cardiac complications. Since July 1974, seven of nine patients underwent a posttraumatic cardiac evaluation. Six of the seven patients were found to have significant cardiac lesions which were unrecognized at the time of initial operation. The incidence of posttraumatic remediable cardiac lesions is probably higher than previously suspected. An aggressive, detailed postoperative evaluation is recommended for all patients with penetrating cardiac injuries.