BACKGROUND: This retrospective study was undertaken to evaluate the efficacy and the complications of the transdiaphragmatic pericardial window (TPW) on the diagnosis of heart injury caused by penetrating wounds. METHODS: During the period of january, 1994 to december, 2004, the pericardial window (PW) was indicated in 245 suspicious cases of cardiac trauma caused by penetrating wounds. In 38 of them (15.5%), PW was accomplished through trandiaphragmatic approach, composing the population of this study RESULTS: The trauma mechanism was gunshot in 26 patients (68.4%) and stab wounds in 12 (31.6%). Most of the patients presented multiple wounds (27 cases - 71%). The RTS average was 7.32 and the PATI average was 9.8. The PW was considered positive in 6 cases (15.8%) of those: 5 (83%) by gunshot e 1 (17%) by stab wounds. There was one patient, with multiple gunshot wounds, that present a positive PW but thoracotomy showed no cardiac injury. The sensibility of TPW was 97.4% and the specificity was 100%. In 12 (31.6%) patients there was association between injury and a perforated hollow gut. There was a single case (2.6%) of complication directly associated to the procedure, being this patient a victim of multiple gunshot wounds with perfurated liver, stomach and colon, who developed pericarditis and needed pericardial drainage, later with good outcome. The mortality rate was 7.9% (3 cases), and one of this patients died in because of postoperative acidosis and coagulopathy. CONCLUSION: The TPW procedure allows rapid diagnostic of cardiac injury in patients who have the lapatotomy as a priority. It is an easy method with high sensibility.
Heart; Pericardial window techniques; Wounds penetrating; Heart injuries
