Videothoracoscopic cardiac exploration: a useful tool for diagnosing and treating thoracic wounds

Objectives: To evaluate the role of videothoracoscopic cardiac exploration (VCE) to diagnose and treat stable patients with a chest wound in ‘the cardiac box’.

Methods: All hemodynamically stable patients, with a penetrating chest wound close to the heart, were proposed for videothoracoscopy. Pericardoscopy was carried out by introducing the videoendoscope into the pericardium.

Results: Eight male patients, average age 25 years (range: 22-42 years), were investigated using VCE. All wound-entry points were in the left hemithorax, and the wounds were inflicted by knives (n=6), a Tahitian arrow (n=1), and an air-compressed nail (n=1). Pericardoscopy was carried out in three patients. Recurrence of active bleeding was found in two patients and a healed right-ventricular wound without active bleeding in one patient. Myocardial suture was performed through a sternotomy to repare a left-ventricular wound and through an anterolateral thoracotomy to control the left anterior descending coronary artery at the apex.

Associated procedures were removal of a dagger under direct vision (n=1), removal of an intra-thoracic foreign body (n=1), Endo-GIA stapling of lung wounds (n=4), direct suturing of diaphragmatic wounds (n=1), and hemostasis of the intercostal artery (n=2). No deaths and no significant complications occurred in the immediate postoperative period or after follow-up at 3 months.

Conclusions: Videothoracoscopic cardiac exploration appears to be an accurate and  reliable method for diagnosing and treating thoracic wounds.