I read with interest the article by Hsia et al. regarding penetrating cardiac injury (
1). As the authors mentioned, advances in technology have provided an increasing number of diagnostic procedures for penetrating cardiac injuries. Today, ultrasound is the initial modality for the evaluation of patients with penetrating precordial wounds because it is accurate, rapid, and non-invasive. Subxiphoid pericardial window was the gold standard for the diagnosis of penetrating cardiac injuries in stable patients up to the mid 1990s (
- Hsia R.Y.
- Mahadaven S.V.
- Brundage S.I.
Penetrating cardiac injury from a wooden knitting needle.
J Emerg Med. 2012; 43: 116-119
2). This procedure is rapid, precise, and safe, though invasive. Our experience with the subxiphoid pericardial window was very rewarding, with no false-positive or false-negative results (
- Asensio J.A.
- Stewart B.M.
- Murray J.
- et al.
Penetrating cardiac injuries.
Surg Clin North Am. 1996; 76: 685-723
3). Similar results have been reported by others (
- Andrade-Alegre R.
- Mon L.
Subxiphoid pericardial window in the diagnosis of penetrating cardiac trauma.
Ann Thorac Surg. 1994; 58: 1139-1141
- Duncan A.O.
- Scalea T.M.
- Sclafani S.J.A.
- et al.
Evaluation of occult cardiac injuries using subxiphoid pericardial window.
J Trauma. 1989; 29: 955-959
5). The ratio between hemopericardium and pericardial window was 21%, which means that almost 80% of subxiphoid pericardial windows performed were negative, but in those years this was the most accurate procedure to diagnose or rule out a cardiac injury. We also have moved to the ultrasound as the initial assessment in penetrating trauma cases with risk of cardiac injury. Subxiphoid pericardial window has been left for doubtful ultrasound readings or inexplicable hypotension in multiple trauma patients undergoing emergency abdominal surgery.
- Brewster S.A.
- Thirlby M.D.
- Snyder W.H.
Subxiphoid pericardial window and penetrating cardiac trauma.
Arch Surg. 1988; 123: 937-941
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- Penetrating cardiac injury from a wooden knitting needle.J Emerg Med. 2012; 43: 116-119
- Penetrating cardiac injuries.Surg Clin North Am. 1996; 76: 685-723
- Subxiphoid pericardial window in the diagnosis of penetrating cardiac trauma.Ann Thorac Surg. 1994; 58: 1139-1141
- Evaluation of occult cardiac injuries using subxiphoid pericardial window.J Trauma. 1989; 29: 955-959
- Subxiphoid pericardial window and penetrating cardiac trauma.Arch Surg. 1988; 123: 937-941
Published online: December 19, 2011
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Penetrating Cardiac Injury from a Wooden Knitting NeedleJournal of Emergency MedicineVol. 43Issue 1
- PreviewMost cases of penetrating cardiac trauma result in death from complications such as cardiac tamponade, exsanguination, coronary artery laceration, valvular disturbances, disruption of conduction pathways, or other associated lethal injuries such as mediastinal major vascular injury (1). Indeed, Hippocrates is credited with the ancient saying that any wound to the heart is fatal. Yet, an estimated 20% of penetrating injuries to the precordium present to the hospital with some signs of life, and the survival rate for patients with recordable vital signs ranges from 40–70% (2,3).