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Effect of cardiac stabbing on ventricular function: evaluation by radionuclide angiography.

OBJECTIVE
To determine whether cardiac stab wounds cause early ventricular dysfunction.


DESIGN
Retrospective case series over 7 years.


SETTING
University-affiliated teaching hospital.


PATIENTS
Nine consecutive survivors of cardiac stab wounds.


INTERVENTIONS
Postoperative radionuclide angiography performed in all patients between 1 and 13 days after injury.


MAIN OUTCOME MEASURES
Information on the patient's clinical presentation and hospital course was obtained from the patient's charts and correlated with ventricular function as measured by the right and left ventricular ejection fractions (RVEF and LVEF).


RESULTS
Cardiac injuries consisted of isolated right (five) and left (three) ventricular lacerations, and one biventricular laceration. Three patients had perioperative dysrhythmias (two ventricular, one atrial), and nonspecific electrocardiographic changes occurred in seven patients. Six patients had postoperative complications: pericarditis in three and pneumonia, pulmonary thromboembolism and abdominal wound dehiscence in one each. The LVEF was normal in all patients. Although none had clinically apparent cardiac dysfunction at the time of radionuclide angiography, six patients had a reduced RVEF (less than 0.45). All patients remained asymptomatic at the time of discharge from hospital (median 12 days postoperatively). In two of the six patients who had a reduced RVEF, one had a normal RVEF 2 months later; the other had a near-normal RVEF (0.43) but had persistent right ventricular enlargement 7 months later. Both were asymptomatic.


CONCLUSIONS
Although a reduced RVEF is common in survivors of cardiac stab wounds, the reduction is small and is not associated with clinically apparent cardiac dysfunction.