Cardiac Tumor and Trauma Surgery

Cardiac Tumor and Trauma Surgery

TUMOR EXCISION

Tumors of the heart are rare; most (75% to 88%) are benign (Braunwald et al., 2001; Kamiya et al., 2001). Primary tumors occur in less than 1% of the population; metastatic tumors have been reported in 1.5% to 35% of oncology patients (Braunwald et al., 2001; Reynan, 1996; Shapiro, 2001). Tumors may be sites for thrombus formation and therefore create a risk of embolism. Dysrhythmias may occur as the myocardium or conduction system is affected.

Surgical excision is performed to prevent obstruction of a cham-ber or valve. Cardiopulmonary bypass is used, except for epicar-dial tumors, which can be excised without entering the heart and without stopping the heart from beating. The tumor location may necessitate valve replacement, myocardial patching, or pace-maker implantation. The nursing care is the same as that for patients undergoing other forms of cardiac surgery .

TRAUMA REPAIR

Patients who have sustained nonpenetrating (ie, blunt force) injury or penetrating injury (eg, gunshot wound, stabbing) caus-ing cardiac trauma often do not survive to treatment (Flynn & Bonini, 1999; Thourani et al., 1999). Patients who do survive to treatment often require surgical treatment (Thourani et al., 1999; Wall et al., 1997). The repairs are typically to the valves or septum in blunt force injuries and to the ventricular and atrial walls in penetrating injuries. The wound is débrided and closed surgically when possible, but valve repair and replacement or patch grafts of the septum and atrial or ventricular walls may be required. The surgery is usually an emergency procedure, and the risk of com-plications from the injury and surgery is high. The nursing care is the same as that for patients undergoing other forms of cardiac surgery .