Heart and great vessel injuries

Abstract

Blunt trauma to the heart and great vessels is often secondary to a high-energy impact to the thorax, leading to major injuries that can be rapidly fatal in many circumstances. Those patients who arrive to the emergency room with signs of life are candidates for an immediate thoracotomy. Patients who are stable may be candidates for diagnostic imaging, including ultrasonography, computed tomography, and invasive arteriography. The initial management of all patients should follow ATLS guidelines. Following the decision to proceed to surgery, an appropriate incision that maximizes access to key structures should be chosen. Full-thickness sutures for atrial lesions will avoid tearing of this thin tissue. Pledgeted sutures may be necessary for partial-thickness sutures in the ventricles. Injury to the great vessels requires proximal (i.e., hilar clamping) and distal control, and extracorporeal membrane oxygenation (ECMO) may be required in select patients following surgical correction of bleeding. Early involvement of cardiothoracic surgeons is often beneficial to help optimize overall care.