Subxiphoid pericardial window and penetrating cardiac trauma
S. A. Brewster, R. C. Thirlby and W. H. Snyder 3rd
Department of Surgery, University of Texas Health Science Center, Dallas.
Between 1982 and 1986, 108 patients with penetrating wounds in proximity to
the heart and no obvious signs of cardiac injury underwent a diagnostic
subxiphoid pericardial window procedure. Eighty-four patients had stab
wounds, 22 had gunshot wounds, and two had shotgun wounds. The subxiphoid
pericardial window procedure produced positive results in 30 patients (28%)
and negative results in 78 patients (72%). There were two false-positive
subxiphoid pericardial window procedures. Eleven patients (39%) with
cardiac injuries were not hypotensive and did not have signs or symptoms of
cardiac injuries prior to the subxiphoid pericardial window procedure. When
they were obtained (n = 80), electrocardiograms were abnormal in 57% and
21% of patients with and without cardiac injuries, respectively. At
thoracotomy, 28 patients had injuries (ventricle, 20; atrium, three; and
pericardium, five) and 21 required suture repair. Thirty-nine patients
underwent a concomitant laparotomy. Forty-six abdominal visceral injuries
were identified in 28 patients, including 21 hollow viscus injuries. There
was no significant short-term or long-term morbidity (eg, pericarditis,
tamponade, or post-pericardiotomy syndrome) attributable to the subxiphoid
pericardial window procedure. There were no known missed cardiac injuries,
and there were no deaths in the series. Some patients with penetrating
wounds to the heart have no overt signs or symptoms of cardiac injury. A
subxiphoid pericardial window procedure quickly identifies or excludes
cardiac injuries and can be performed with minimal morbidity, even when
there is contamination from the gastrointestinal tract.