Injuries to the heart and thoracic great vessels

Abstract

Background: Injuries to the heart and thoracic great vessels are frequently lethal. As prehospital care improves, however, more patients with these injuries are reaching the hospital alive. Thus, the trauma surgeon must be prepared to deal with them rapidly and precisely. Methods: A review of current literature was performed and summarized to provide a concise approach to these injuries. Results: Penetrating cardiac wounds present with either tamponade or hemorrhage; both must be quickly diagnosed and treated. Blunt cardiac injuries range from occult and inconsequential to rapidly lethal. Thoracic great vessel injuries often cause death in the field. Conversely, in those patients who survive to reach the hospital, blunt great vessel injuries present a challenge in rapid detection, as they are often occult. Aortography and repair with active bypass shunts provide the standard of care. Conclusions: Heart and thoracic great vessel injuries challenge the trauma surgeon. The patients who survive to reach the hospital may be in extremis, or they may be asymptomatic with the potential for precipitous deterioration. A high index of suspicion and focused approach is critical to patient survival.