Blunt Cardiac Rupture: A 5-Year NTDB Analysis

Teixeira, Pedro G.R.; Inaba, Kenji; Öncel, Didem; DuBose, Joseph J.; Chan, Linda S.; Rhee, Peter; Salim, Ali; Browder, Timothy; Brown, Carlos; Δημητριάδης, Δημήτριος

doi:10.1097/ta.0b013e3181825bd8

Cited by 72 publications

(94 citation statements)

References 26 publications

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“…Blunt Cardiac Injuries (BCI), which in addition to BCR also include injuries such as myocardial contusion, have been reported in 8 to 86% of cases of blunt chest trauma and are associated with high mortality rates [1]. According to Kulshreshtha P et al, 2.2% of BCI reached the hospital alive as compared to 17.4% of penetrating cardiac injuries and unlike penetrating cardiac injuries in which the wound of entry is suggestive, blunt cardiac injuries often go unsuspected [2].…”

Section: Discussionmentioning

confidence: 99%

“…Though it has been more than six decades since the first reported successful treatment of BCR in 1955 [3], little progress has been made in defining nomenclature and treatment guidelines for the same. Motor vehicle accidents are the most common mode of blunt cardiac injuries [1,4,5]. BCR is associated with mortality rates ranging from 50 to 100 percent [4,6,7].…”

Section: Discussionmentioning

confidence: 99%

“…BCR is associated with mortality rates ranging from 50 to 100 percent [4,6,7]. A number of mechanisms have been hypothesised for BCR which include deceleration injury, compression of heart between the sternum and vertebral column, rib fractures or transmission of venous pressure due to compression of abdomen or lower extremities [1,5,8,9]. The site of rupture depends on the phase of cardiac cycle where the blunt trauma occurred [8,9].…”

Section: Discussionmentioning

confidence: 99%

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Blunt Cardiac Rupture: A Diagnostic Challenge

Pinni

Kumar

Dharap

2016

JCDR

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A 22-year-old unidentified male was brought to the emergency room with history of road traffic crash, with no witnesses to the accident. At presentation, patient was agitated, drowsy and diaphoretic with tachycardia of 130/min and Blood Pressure (BP) of 78mmHg systolic. There was bilaterally equal air entry, mild abdominal tenderness and blood tinged urine on inserting Foley catheter.On fluid resuscitation, BP transiently rose and patient became responsive and obeyed commands. BP showed downward trend to 70 mmHg systolic over next ten minutes and Central Venous Pressure (CVP) was found to be 20cm of H 2 O. Heart sounds were muffled on auscultation. Chest radiograph was suggestive of a widened mediastinum [Table/ Fig-1]. Pelvic radiograph was suspicious of pubic diastasis suggestive of open book pelvic fracture. The hospital ultrasound machine was out of order and patient was unstable to be shifted to radiology suite for Focused Assessment by Sonography in Trauma (FAST) or Trans Thoracic Echocardiography (TTE).A primary diagnosis of cardiac tamponade was considered and urgent cardiac surgery consultation was sought. The patient was intubated in view of progressive hypotension. On reassessment, air entry was reduced bilaterally, hence, bilateral intercostal drains were inserted and pneumothorax was drained bilaterally. Subsequently, air entry improved bilaterally. CVP persisted to be 20cm of H 2 O and patient continued to be hypotensive. Blind pericardiocentesis was attempted unsuccessfully. Patient was shifted into the operation theatre and subxiphoid pericardial window revealed a bulging pericardium. Diagnostic Peritoneal Lavage (DPL) was also done which showed haemoperitoneum. Median sternotomy was done and 250ml of clots and blood was evacuated on opening pericardium, following which BP showed an upward trend. A 0.5 cm actively bleeding rent was identified on right atrial appendage [Table /Fig-2]. The rent was closed with 5-0 polypropylene suture in two layers. Laparotomy was done and 600ml haemoperitoneum was evacuated. Splenectomy was done for grade four laceration. Large non-expanding pelvic and retroperitoneal hematoma and a small non-bleeding liver laceration were left untouched. Patient was transfused four units of blood and fresh frozen plasma each. Patient made an uneventful recovery. A postoperative TTE showed no abnormality. Patient also had a tibial spine avulsion fracture Blunt Cardiac Rupture (BCR) is a life threatening injury. Majority of patients do not reach the hospital and in those who reach the emergency department, timely diagnosis and treatment is a challenge. The case is about a patient with multiple blunt injuries who presented in shock. Cardiac tamponade was suspected on clinical grounds and on evidence of mediastinal widening on radiograph. In the absence of songography, the diagnosis was confirmed by subxiphoid pericardial window. Emergency thoracotomy revealed a right atrial appendage rupture which was surgically corrected. The patient also underwent splenectomy for grade IV splenic ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Blunt Cardiac Rupture: A Diagnostic Challenge

Pinni

Kumar

Dharap

2016

JCDR

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“…Because of the low-pressure chamber, unlike ventricle ruptures, immediate death is delayed in atrial rupture [7]. National trauma data bank reports that the chamber tears make the 0.041% of all trauma cases and there is a mortality rate of 89.2% [4].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of injury of heart and major vessels with blunt chest traumas varies between 4% and 1%5 [3]. Cardiac rupture is a rare complication which occurs in 1 of 2400 blunt truma patients [4]. In 160 autopsies in trauma, where the cause is blunt mechanisms, cardiac rupture was found in 96.9% [5].…”

Section: Discussionmentioning

confidence: 99%

Left atrial appendage tear due to blunt chest trauma: off-pump repair

Tayfur¹,

Yalçın²,

Yazman³

et al. 2016

Eur Res J

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Left atrial appendage tear due to blunt trauma is a very rare clinical entity with high mortality rates. Traumatized patients may have no symptoms, or be in a cardiogenic shock state. For diagnosis, it is crucial to determine hemopericardium by echocardiography. Herein, we report a 28-year-old male patient who developed left atrial appendage tear following a fall from a higher distance. He underwent successful off-pump repair of the tear through a median sternotomy.Eur Res J 2016;2(3):225-227

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