• Journal of Chest Surgery
• /
• 제37권12호
• /
• pp.999-1002
• /
• 2004

흉부관통상 환자에서 심장손상이 의심될 때 신속한 이송, 조기 진단 및 체계적인 수술적 치료는 좋은 결과를 얻을 수 있다. 생명을 위협하는 응급상황에서 심장손상의 정도를 진단하는 것은 어려울 수도 있다. 13세 남아가 칼에 의한 흉부 관통상을 입고 흉관으로부터 과도한 출혈이 있어 본원 흉부 외과로 전원되었다. 단순 흉부촬영에서 좌측페야에 균일한 음영 증가가 관찰되었다. 그는 의식이 혼미했으며 생체의 징후는 불안정하여 신속히 수술실로 옮겼다. 소생술 후 정중 흉골절개술을 통해 좌심실 열상을 봉합하였다. 수술 중 시행한 경식도 심초음파에서 심실중격결손에 의한 단락이 발견되었고 좌심실절개하에 데크론 첨포(Dacron patch)를 이용하여 정복하였다. 수술 후 경과는 좋았으며 심실중 격결손을 통한 작은 단락이 있었으나 추적 관찰하기로 하고 퇴원하였다.

• Journal of Chest Surgery
• /
• 제17권4호
• /
• pp.715-722
• /
• 1984

From 1978 to April 30 84 thirteen cases of cardiac injured patients were operated under general anesthesia at Department of Thoracic and Cardiovascular Surgery in Chonnam National University. These patients were divided Into two groups according to their cause of trauma: Group 1, penetrating cardiac injury and Group II, blunt cardiac injury. 1.In 7 cases of Group 1, 6 cases were stab wound and one case was gunshot wound, and among 6 cases of Group II, 3 cases traffic accident, 2 cases pedestrian, 1 case agrimotor accident. 2.The sites of cardiac injury in penetrating trauma were right ventricle mainly and the next left ventricle and in blunt trauma right ventricle, myocardial contusion, right atrium, and inferior vena cava in order. 3.In most of cases central venous pressure was elevated above 15 cmH2O and in 5 of 13 cases revealed cardiomegaly in simple chest X-ray. 4.The relationship between the condition on arrival and the time to operation is not significant. 5.Associated injuries in penetrating cardiac trauma were hemothorax, pneumothorax, laceration of lung and in blunt trauma hemothorax, sternal fracture, rib fracture and pneumothorax in order. 6.One case of gunshot injury died after operation.

• Journal of Trauma and Injury
• /
• 제36권3호
• /
• pp.253-257
• /
• 2023

A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.

• Journal of Trauma and Injury
• /
• 제30권4호
• /
• pp.166-172
• /
• 2017

Purpose: Thoracic traumas represent 10-15% of all traumas and are responsible for 25% of all trauma mortalities. Traumatic cardiac injury (TCI) is one of the major causes of death in trauma patients, rarely present in living patients who are transferred to the hospital. TCI is a challenge for trauma surgeons as it provides a short therapeutic window and the management is often dictated by the underlying mechanism and hemodynamic status. This study is to describe our experiences about emergency cardiac surgery in TCI. Methods: This is a retrospective clinical analysis of patients who had undergone emergency cardiac surgery in our trauma center from January 2014 to December 2016. Demographics, physiologic data, mechanism of injuries, the timing of surgical interventions, surgical approaches and outcomes were reviewed. Results: The number of trauma patients who arrived at our hospital during the study period was 9,501. Among them, 884 had chest injuries, 434 patients were evaluated to have over 3 abbreviated injury scale (AIS) about the chest. Cardiac surgeries were performed in 18 patients, and 13 (72.2%) of them were male. The median age was 47.0 years (quartiles 35.0, 55.3). Eleven patients (61.1%) had penetrating traumas. Prehospital cardiopulmonary resuscitations (CPR) were performed in 4 patients (22.2%). All of them had undergone emergency department thoracotomy (EDT), and they were transferred to the operating room for definitive repair of the cardiac injury, but all of them expired in the intensive care unit. Most commonly performed surgical incision was median sternotomy (n=13, 72.2%). The majority site of injury was right ventricle (n=11, 61.1%). The mortality rate was 22.2% (n=4). Conclusions: This study suggests that penetrating cardiac injuries are more often than blunt cardiac injury in TCI, and the majority site of injury is right ventricle. Also, it suggests prehospital CPR and EDT are significantly responsible for high mortality in TCI.

• Korean Circulation Journal
• /
• 제48권11호
• /
• pp.1014-1024
• /
• 2018

Background and Objectives: Intense exercise (IE) induced myocardial fibrosis (MF) showed contradictory findings in human studies, making the relationship between IE and the development of MF unclear. This study aims to demonstrate exercise induced MF is associated with cardiac damage, and inflammation is essential to the development of exercise induced MF. Methods: Sprague-Dawley rats were submitted to daily 60-minutes treadmill exercise sessions at vigorous or moderate intensity, with 8-, 12-, and 16-week durations; time-matched sedentary rats served as controls. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum cardiac troponin I (cTnI) concentration. After completion of the exercise protocol rats were euthanized. Biventricular morphology, ultrastructure, and collagen deposition were then examined. Protein expression of interleukin $(IL)-1{\beta}$ and monocyte chemotactic protein (MCP)-1 was evaluated in both ventricles. Results: After IE, right but not left ventricle (LV) MF occurred. Serum cTnI levels increased and right ventricular damage was observed at the ultrastructure level in rats that were subjected to long-term IE. Leukocyte infiltration into the right ventricle (RV) rather than LV was observed after long-term IE. Long-term IE also increased protein expression of proinflammation factors including $IL-1{\beta}$ and MCP-1 in the RV. Conclusions: Right ventricular damage induced by long-term IE is pathological and the following inflammatory response is essential to the development of exercise induced MF.

• Journal of Chest Surgery
• /
• 제56권6호
• /
• pp.456-459
• /
• 2023

Penetrating chest trauma may result in significant intracardiac injury. A traumatic ventricular septal defect is a rare complication that requires surgical management, particularly if heart failure ensues. We report a case of delayed repair of an outlet-type ventricular septal defect and perforation of the aortic and pulmonary valve leaflets following a stab wound. This report highlights diagnostic and surgical considerations and also presents an opportunity to review the conotruncal anatomy, which may be relatively unfamiliar to many adult cardiac surgeons.

• Journal of Chest Surgery
• /
• 제40권12호
• /
• pp.831-836
• /
• 2007

배경: 심장 손상은 외상으로 사망한 환자에서 가장 많이 간과되는 손상이다. 둔상이나 관통상으로 생존하는 환자는 드물며 그리고 발생률은 아직 명확하지가 않다. 많은 수의 환자에서 긴급 또는 응급수술을 요하며 또한 사망률이 매우 높다. 대상 및 방법: 1997년 2월부터 2005년 12월까지 흉부외상으로 심장손상을 입은 응급 흉부 절개술을 한 26명의 환자를 후향적으로 조사하였다. 결과: 남자가 17명, 여자가 9명이고 평균나이는 $45.3{\pm}16.2$세($17{\sim}80$세)였다. 13명(50%) 환자는 자동차 사고, 5명(19%)의 환자는 오토바이사고로 손상을 입었다. 6명(23%)의 환자는 칼에 의해, 2명(8%)의 환자는 작업 중 높은 곳에서 떨어져서 손상을 받았다. 손상 받은 심장은 우심방 12예(46%), 좌심방 1예(4%), 우심실 5예(19%), 좌심실5예(19%) 그리고 두 곳의 심장손상이 2예(7%)였다. 진단은 12예의 환자에서는 컴퓨터 단층촬영으로, 14예의 환자는 초음파를 이용하여 진단하였다. 입원에서 수술실까지 걸린 시간은 평균$89.2{\pm}86.7$분($10{\sim}335$)이었고, 평균 진단시간은 $51.3{\pm}13.6$분(5-280)이었다. 외상인자로 개정 외상 계수, 글라스고우 혼수 계수의 평균이 $6.7{\pm}0.8,\;12.8{\pm}2.8$이었다. 사망률은 12%였다. 결론: 심장손상으로 인한 사망률은 매우 높다. 높은 관심과, 적극적이고 신속한 진단, 그리고 즉각적이고 적절한 외과적인 치료가 환자의 생존율 높일 수 있다.