Cardiac War Injuries, Management of Penetrating Cardiac ShrapnelA

Background: Penetrating cardiac injuries pose great challenge in diagnosis as well as management. Military weaponry shrapnel injuries are rare and seldom reported.

Objectives: To review our experience in managing penetrating shrapnel to the heart due to combat injuries.

Methods: Retrospective review of medical records of all the injured admitted with penetrating shrapnel chest injuries due to combat injuries. Only wounded with cardiac injuries were included.

Results: Over a two-year period (August 2013- October 2015) 8 patients were identified with penetrating shrapnel injuries to the pericardium and/ or the heart resulting from combat etiology. Seven males and one one female patient, mean age was 26.6 years (Range 13 – 47 years). Associated injuries were common. Five patients were awake and alert and three were mechanically ventilated. All had FAST, CT and Echocardiography studies. Five had positive FAST for the pericardial fluid. CTA demonstrated the shrapnel location. In 5 patients the shrapnel penetrated into the pericardial space, in 2 patients penetration into the myocardium was identified and in one patient the shrapnel penetrated the right atrium. One patient underwent percutaneous pericardiocenthesis. The female patient was operated due to Intracardiac mobile shrapnel. Six patients were treated non-operatively. One patient in the non-operative group died (14%) due to severe head injury.

Conclusion: Non operative management of penetrating pericardial or myocardial shrapnel injuries in hemodynamically stable patients may be managed non-operatively. Strict evaluation and monitoring are mandatory. Intracardiac mobile shrapnel might present a surgical indication.