Pericardial window used in the diagnosis of cardiac injury

Abstract

Purpose:The purpose of the present study is to analyze the results of subxiphoid pericardial window (SPW) and transdiaphragmatic pericardial window (TDP) procedures comparing the two techniques. Methods: During the period of January, 1994 to December, 2004, at UNICAMP, 245 patients underwent a pericardial window (PW) procedure to evaluate the possibility of cardiac injury. We reviewed the medical records of those patients in order to compare both procedures. Results: Two hundred and seven patients (84.5%) underwent the SPW procedure, and 38 (15.5%) underwent the TDP procedure. Of the patients who underwent a SPW procedure, 151 (72.9%) had gunshots injuries, and 56 (27.1%) had stab wounds. In the group of patients submitted to TDP procedure, the wound was caused by gunshot in 26 (68.4%). The SPW method has shown a sensitivity of 97.5%, specificity of 95.8%, and an accuracy of 96.1%. The TDP method demonstrated a sensitivity of 100%, specificity of 97% and a 97.4% of accuracy rate. This review showed 8 (3.3%) false positive results. There was a single case (2.6%) of complications directly associated to the TDP, and this patient developed pericarditis. Conclusions: Both techniques presented an equally great result, with high sensitivity and specificity. Both surgical techniques must be carefully done to avoid false positive results.Key words: Trauma. Penetrating wounds. Thoracic injuries. Heart. Pericardial window techniques. RESUMOObjetivo: Analisar os resultados da janela pericárdica subxifóidea (JPSX) e da janela pericárdica transdiafragmática (JPTD), comparando as duas técnicas. Métodos: Durante o período entre Janeiro de 1994 a Dezembro de 2004, 245 pacientes foram submetidos à janela pericárdica (JP) na Unicamp, a fim de avaliar a presença de lesão cardíaca. Foram revisadas as informações destes pacientes a fim de comparar as técnicas de JP. Resultados: Duzentos e sete (84,5%) pacientes foram submetidos à JPSX, e 38 (15,5%) à JPTD. Dos pacientes que realizaram a JPSX, 151 (72,9%) foram vítimas de lesões provocadas por projétil de arma de fogo (FPAF), e 56 (27,1%) por arma branca (FAB). Em relação aos pacientes submetidos à JPTD, o ferimento foi causado por FPAF em 26 (68,4%). O método JPSX teve uma sensibilidade de 97,5%, especificidade de 95,8%, e uma acurácia de 96,1%. A JPTD resultou numa sensibilidade de 100%, especificidade de 97% e 97,4% de acurácia. Em 8 pacientes (3,3%) o resultado foi falso-positivo. Houve um único caso (2,6%) de complicação diretamente relacionada à JPTD. Conclusões: Ambas as técnicas apresentaram um bom resultado, com alta sensibilidade e especificidade. Entretanto, estes procedimentos cirúrgicos devem ser efetuados com cuidado, a fim de evitar resultados falso-positivos.Descritores: Trauma. Ferimentos penetrantes. Lesões torácicas. Coração. Técnicas de janela pericárdica.

Subxiphoid pericardial window to exclude occult cardiac injury after penetrating thoracoabdominal trauma

“…This wide variation reflects the proportion of gunshot wounds (GSWs) included in a particular series. Patients with penetrating thoracoabdominal injuries have a 20–30 per cent risk of cardiac injury where the tract overlies the cardiac silhouette.…”

Performance, pain, and quality of life on use of central venous catheter for management of pericardial effusions in patients undergoing coronary artery bypass graft surgery

“…Moreover, the incision made through performing this technique is smaller compared to the incision made for pericardial window, which may explain the zero rates of mortality, morbidity, infection, and complications. Recent studies recommend the pericardial window for a quick diagnosis of cardiac injury, as several researchers have presented their own account of performing the pericardial window technique for diagnosing cardiac injury in patients with stable conditions 22–24. According to the majority of these studies, pericardial window is a standard technique, as it helps to detect or rule out cardiac injuries and is associated with the lowest morbidity rates, even if the gastrointestinal tract has been identified as a source of contamination 22…”

Estudo retrospectivo de ferimentos cardíacos ocorridos em Manaus/AM

“…The stab wound is considered less severe than that produced by gunshots and is thus associated with a better prognosis 4,9,17,30,36 . Spencer Neto et al 36 drew attention to this issue by mentioning the probable selection of patients arriving with vital signs to Table 4 -Table 4 - Table 4 - Table 4 - Table 4 the operating room and therefore with less myocardial damage. His hypothesis is confirmed when analyzing violent deaths in the state of Pernambuco in 1991, where 70% of trauma deaths were produced by firearms.…”

“…Of these, 63.4% received between one and three units of packed red blood cells. Spencer Neto et al 36 concluded that patients who required more than three units of packed red blood cells in the pre and trans-operative periods had a higher relative risk of death; those who did not require transfusion, survived. Reversely, in our series there was no time to require transfusion in 20 cases and mortality reached 40%.…”