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Diagnostic Pericardial WindowA Safe Alternative to Exploratory Thoracotomy for Suspected Heart Injuries
Frank B. Miller, MD;
Sheldon J. Bond, MD;
Charles R. Shumate, MD;
Hiram C. Polk, Jr, MD;
J. David Richardson, MD
Arch Surg. 1987;122(5):605-609.
Abstract
• During a five-year period, 104 patients underwent a pericardial window procedure to diagnose possible cardiac injury. Eighty-eight procedures were performed by a subxiphoid approach, and 16 were transdiaphragmatic in combination with an exploratory laparotomy. There were 51 patients with stab wounds, 45 with gunshot wounds, and eight with blunt trauma. All penetrating wounds were near the heart. In seven patients the window disclosed cardiac damage with no clinical signs of tamponade or shock. Fifty-one patients had signs of tamponade; however, only 12 of them had a cardiac injury diagnosed by pericardial window. Nineteen patients had cardiac injuries. One examination had false-negative results and one study had false-positive results. Cardiac wounds repaired included the right ventricle (eight), left ventricle (three), right atrium (five), and cardiac vein or pericardial wounds (three). Complications were negligible and consisted of minor wound infections (two) and postpericardiotomy syndromes (two). The pericardial window provides a rapid and safe means of diagnosing cardiac injuries in patients with equivocal signs of heart injury while sparing the patient without a heart wound a major operation.
(Arch Surg 1987;122:605-609)
Author Affiliations
From the Department of Surgery, University of Louisville School of Medicine.
Footnotes
Accepted for publication Jan 16, 1987.
Read before the 94th Annual Meeting of the Western Surgical Association, Dearborn, Mich, Nov 19, 1986.
Reprint requests to Department of Surgery, University of Louisville, Louisville, KY 40292 (Dr Miller).
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