Subxiphoid pericardial window to exclude occult cardiac injury after penetrating thoracoabdominal trauma (Br J Surg 2013; 100: 1454-1458)

摘要

Up to 40 per cent of penetrating trauma to the thoracoabdominal region will result in both thoracic and abdominal injuries1. Cardiac injuries are among the most concerning given the confined and non-distensible pericardial sac. This adds the Ufe-threatening risk of tamponade to the risk of cardiac injury itself. Whether the heart needs repair or only the blood needs to be drained, early recognition is vital to successful management. When patients meet other criteria for immediate surgical exploration such as laparotomy, with the expectation of significant operative intervention, rapid accurate diagnosis cannot delay operative intervention. Focused assessment with sonography for trauma (FAST) examination carries the advantage of being non-invasive and, with some caveats, is highly sensitive and specific. It can be performed rapidly, although it is limited by operator experience and identifies only the result of injury (fluid); furthermore, FAST does not allow either direct inspection of the heart or have the advantage of intervention to manage pericardial blood.