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Invited Commentary

Vernon J. Henderson, MD
Arch Surg. 1993;128(8):841. doi:10.1001/archsurg.1993.01420200015002.
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The authors of this article present their experience with 48 survivors of penetrating cardiac injuries in a Detroit (Mich) area hospital over a 10-year period. They noted delayed cardiac sequelae in 11 patients (23%), including cardiac septal defects, conduction disturbances, and valvular dysfunction. In most cases, the diagnosis of these conditions was made in the immediate postoperative period, and those patients whose lesions required surgical repair experienced 100% survival.

This represents an excellent clinical series and makes a number of key observations in the treatment of patients with penetrating cardiac injuries. This article stresses the importance of focusing on hemorrhage control during the initial operation. No attempts should be made to identify and repair intracardiac injuries at this time as they can be repaired later, under elective conditions, with an excellent prognosis. Although unsubstantiated, a higher mortality would be expected if definitive cardiac repair were undertaken initially in patients who


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