Video-Assisted Thoracoscopy For Penetrating Cardiac Box Injury in Stable Patients.

Eric E Vinck,Juan C Garzón,Sergio A Alzate,Alexander Fernández,Rodolfo V Barrios,Tjark Ebels,Carlos A Arias,Eduardo Posada Ángel,Stella I Martínez

doi:10.21470/1678-9741-2020-0361

Abstract

IntroductionIn high-volume trauma centers, especially in developing countries, penetrating cardiac box injuries are frequent. Although many aspects of penetrating chest injuries have been well established, video-assisted thoracoscopy is still finding its place in cardiac box trauma and algorithmic approaches are still lacking. The purpose of this manuscript is to provide a streamlined recommendation for penetrating cardiac box injury in stable patients.MethodsLiterature review was carried out using PubMed/MEDLINE and Google Scholar databases to identify articles describing the characteristics and concepts of penetrating cardiac box trauma, including the characteristics of tamponade, cardiac ultrasound, indications and techniques of pericardial windows and, especially, the role of video-assisted thoracoscopy in stable patients.ResultsPenetrating cardiac box injuries, whether by stab or gunshot wounds, require rapid surgical consultation. Unstable patients require immediate open surgery, however, determining which stable patients should be taken to thoracoscopic surgery is still controversial. Here, the classification of penetrating cardiac box injury used in Colombia is detailed, as well as the algorithmic approach to these types of trauma.ConclusionAlthough open surgery is mandatory in unstable patients with penetrating cardiac box injuries, a more conservative and minimally invasive approach may be undertaken in stable patients. As rapid decision-making is critical in the trauma bay, surgeons working in high-volume trauma centers should expose themselves to thoracoscopy and always consider this possibility in the setting of penetrating cardiac box injuries in stable patients, always in the context of an experienced trauma team.

Highlights

In high-volume trauma centers, especially in developing countries, penetrating cardiac box injuries are frequent
In Colombia, we use the area defined by Sauer and Murdock, limited superiorly by clavicles and jugular notch in the sternum, laterally between the left Table 1
In patients with no suspicion of associated abdominal injury, a subxiphoid or thoracic (VATS/ parasternal) approach is recommended

Summary

Introduction

In high-volume trauma centers, especially in developing countries, penetrating cardiac box injuries are frequent. Many aspects of penetrating chest injuries have been well established, video-assisted thoracoscopy is still finding its place in cardiac box trauma and algorithmic approaches are still lacking. The purpose of this manuscript is to provide a streamlined recommendation for penetrating cardiac box injury in stable patients. The number of penetrating cardiac injuries by gunshots outnumber stab wounds by a ratio of 2:1[3]. In developing countries such as Colombia, stab wounds are more frequent

Results

Discussion

Conclusion