Missile Cardiovascular Injuries

Background: Missile Cardiovascular injuries have taken epidemic proportion in Kashmir valley since the eruption of militancy in 1990. Present study was undertaken to analyse the mode, pattern, presentation and management of missile cardiovascular injuries. Study Design: Prospective and retrospective. Material & Methods: Retrospective study of patients with missile cardiovascular injury from Jan 1996 to Oct 2008. 386 patients with missile cardiovascular injury were studied. All patients of cardiovascular injury due to causes other than missiles were excluded from the study. Results: All patients of missile cardiac injuries were treated by primary cardiorrhaphy. Right ventricle was the most common chamber affected. Left anterior thoracotomy was most common approach used. Most of the patients of missile vascular group were treated by reverse saphenous vein graft or end to end anostomosis. Most common complication was wound infection (20.83%) followed by graft occlusion (1.94%) in missile vascular group. Amputation rate was 4.66%. Amputation rate was higher in patients with delay of >6 hours and associated fractures. Conclusions: Missile cardiac injuries are becoming common due to use of more sophisticated weapons in domestic violence. Results are best if operated early and outcome depends upon multiple factors including clinical status at arrival, time interval till management, nature of injury and associated injuries. Missile vascular injury needs prompt resuscitation and revascularisation. Preoperative angiography is seldom necessary. Doppler study may sometimes be needed to aid the diagnosis