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An analysis of 293 victims with cardiac and pericardium injuries was made. Cardiac complications could appear suddenly and be registered on any stage of treatment process. They differentiated by character and duration of wound process. Pericarditis took place in 288 patients. The syndrome of system inflammation reaction was noted in 47.9% of patients, a sepsis (sometimes severe sepsis) was in 14.3%. Complications in postoperative period were determined by posthypoxic and hemic hypoxia, coagulopathy. They were manifested by myocardial ischemia and thromboembolic complications. An acute myocardial infarction took place in 29 (9.8%) cases and rhythm and conductivity abnormalities were in 23 (7.8%) patients. The circulatory failure with clinical picture of pulmonary edema was developed in 12 (4.1%) cases. The lethality consisted of 44 (15%) patients.

Results of the emergency diagnosis and surgical treatment of wounds of the heart and pericardium were summed up in 207 wounded during twenty years of work. It was found that injuries of the heart and pericardium were diagnosed in 42% of cases according to clinical symptoms, while emergency thoracotomy during the first minutes after admission to the surgical hospital was performed in 55-60% of wounded to the heart. About half wounded at the moment of admission to the hospital were at the state of relative stabilization of hemodynamic indices and had no clinical symptoms of wounds to the heart. In this group of patients injuries of the heart and pericardium were diagnosed on the basis of additional investigations, extrapleural pericardiotomy (fenestration of the pericardium) being most reliable. The results of treatment of wounded to the heart can be improved at the expense of acute surgical strategy which is determined by the stable state of the wounded, character of the myocardium injury and associated wounds.

A complex investigation of effectiveness of different methods of detection of heart contusion in patients with combined traumas of the chest allowed detailed elucidation of the criteria of diagnostics of heart contusions by means of electrocardiography, integral rheography of the body, ultrasonography, enzyme diagnostics. A comparative analysis has shown that none of the available now methods can be taken as absolute. The complex use of these methods only can make the maximum objective diagnosis of heart contusion. This approach allowed the authors to make the amount of diagnostic errors 18% less in patients with a combined trauma of the chest and thus to improve the results of treatment.

Based on an analysis of results of treatment of 86 patients and wounded with severe combined traumas and gunshot wounds the authors have made a diagnostic scale including 8 most significant symptoms of heart contusions which determine the index MS-HC (military surgery-heart contusion). The value of this index in scores gives a reliable picture of heart contusion. Patients having not less than 15 scores are considered to be in a critical state. Lethality among them was 80%, the survivors had complications in 45% of the cases. The autopsy showed that the diagnosis of heart contusion by the score system was correct and coincided with the autopsy findings in 94.7%. A rational program of intensive therapy for heart contusions is proposed aimed at the maintenance and development of compensatory abilities in the hemodynamic system. The basic drugs are thought to be nitroglycerin, dobutrex (dophamin), neoton. The rational surgical policy for injuries of different areas of the body, terms of its realization, indications related with different degrees of the patient's state are determined. The realization of these approaches to treatment of wounds and traumas involving contusions of the heart made lethality of such patients 27% less.

The work is based on the results of an analysis of medical care of 453 patients with wounds of the heart and pericardium. It has been shown that the successful treatment of such patients is possible only in cases of complete succession of performing medical procedures at the prehospital and hospital stages based on urgent in time and adequate in volume life-saving interventions, arriving to the wounded of a specialist included in the surgical resuscitation team. It was found that in 32.4% of the wounded who died at the prehospital stage the wound of the heart was not absolutely fatal. So, the volume of medical care at the prehospital stage must be wider and more intensive.

The article presents results of treatment of 84 patients with wounds of the heart. Of great importance is to shorten the time from getting the injury to rendering specialized surgical aid. A wider volume of care at the prehospital stage is developed. The creation of a regional program of treatment of patients with chest wounds is thought to be expedient. Lethality was 13%. It was stressed that better results of treatment of patients with heart wounds was dependent not only on using the adequate diagnostic and medical methods but also on the improvement of organization of aid to such people.

Under investigation were specific features of the clinical picture in 34 patients with associated wounds of the heart and pericardium. Four dissimilar clinical groups were established. A comparative analysis of associated and isolated injuries (38 patients) has been made from the viewpoint of frequency of diagnostic errors, volume of the intraoperative blood loss and character of postoperative complications.

The article generalizes experience with the treatment of 91 patients with contusion of the heart (mainly due to a stroke--72%). Within the first three days the diagnosis of heart stroke was established in 76 patients. The left ventricle was injured more frequently, its anterior and posterior surfaces in particular. Lethal outcomes after contusions of the heart were not noted.

The work presents data of 25 patients with wounds of the heart and pericardium. Clinical diagnostics, tactics and results of treatment are described. Attention is called to the importance of the method of thoracoscopy in determination of the character of injuries. To improve results of the treatment of this group of patients, the work of the emergency aid must use resuscitation-surgical teams, admittance of the patients to specialized departments for thoracal traumas.

In the peace time wounds of the heart occur in 13-15% of penetrating injuries of the chest. Of leading importance in diagnostics of heart wounds is the triad of symptoms: hemorrhage, tamponage of the heart, wound in the heart projection. The main task in the treatment of heart wounds is to suture the wound.

Forty observations of damaged hearts and pericardium in thoracoabdominal wounds were studied. All the patients were operated on. Causes of diagnostic errors and erroneous choice of surgical methods are analyzed. It is found that 61% of patients with heart damage in thoracoabdominal wounds are admitted to hospitals and given urgent surgical aid. Fifteen patients were examined in the long-term postoperative period.

Among 420 cases of wounds and injuries to the heart and the pericardium the authors observed 18 children (4 girls and 14 boys). 11 children died: 7 of them died on the spot, 4 in surgical clinics; 7 children recovered, 4 of them developed complications.

On the basis of statistical analysis of chest wounds in 349 patients the authors have determined the "risk zone". Wounds in this zone have the greatest probability to injure the heart. The zone is restricted by the II-VIII ribs on the left and III-VIII ribs on the right, left medioaxillary and right parasternal lines.

Experiences with diagnostics of contusion of the heart in 96 patients were analyzed. A complex of methods has been proposed for express-diagnostics of contusion of the heart which allowed the contusion to be reliably differentiated from other manifestations of the trauma disease. Topographic anatomic peculiarities of the injury were established more exactly as well as a degree of the trauma and the adequate treatment could be started in due time. The outcomes of the trauma became better, lethality was reduced.

The authors experience with surgical treatment of heart and pericardium injuries is summarized. A total of 38 patients were operated upon. The surgical aid consisted in simultaneous performance of the complex of reanimation measures, urgent thoracotomy and suturing of the heart wound. Thirty six patients have recovered, two died. One patient died due to mediastinitis, the other -- due to progressive cardiovascular insufficiency.

An analysis of 136 clinical observations has shown that clinical symptoms and additional methods of examination (X-ray analysis of the chest, ECG, puncture of the pleura and pericardium) are sufficient for timely diagnosis of wounds of the heart and pericardium. The necessity of urgent operation prevents using complex diagnostic methods. Outcomes of the treatment are dependent on the time of admission of the patient to the hospital and timely operative interventions.