Changing Patterns of Surgical Management

General policy regarding management of penetrating wounds of the chest in the charity hospitals of Houston and Harris County, Texas, has been to institute resuscitative measures immediately and to reserve thoracotomy for specific indications. This policy has been found applicable to both stab and gunshot wounds of the heart, and primary therapy has consisted of restoration of circulating blood volume, pulmonary reexpansion, and relief of pericardial tamponade when present. Thirty-one gunshot wounds of the heart managed in this manner up to January, 1963, have been reported from this center previously. Thoracotomy was performed in only 17 patients. Since that time another 35 patients have been treated for gunshot wounds of the heart. All underwent thoracotomy and cardiorrhaphy with similar overall results, but there were significant differences in individual groups. Analysis of the total group of 66 patients with gunshot wounds of the heart demonstrates that such changing patterns of surgical management relate to a variety of factors and that the results achieved support these changes. It now appears that thoracotomy and cardiorrhaphy without primary pericardiocentesis is a satisfac- tory method of management for a significant number of patients with gunshot wounds of the heart. ulnerability of the heart to an assailant's weapon probably was recognized before recorded history. The life-threatening po- tential of attack upon the heart was described clearly by Homer in The Iliud (13):