Blunt traumatic cardiac rupture: Therapeutic options and outcomes

Nan, Yu-Yun; Lu, Ming‐Shian; Liu, Kuo‐Sheng; Huang, Yao‐Kuang; Tsai, Feng‐Chun; Chu, Jaw‐Ji; Lin, Pyng Jing

doi:10.1016/j.injury.2009.05.016

Cited by 77 publications

(84 citation statements)

References 18 publications

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“…A diagnosis of BCI can be made rapidly by FAST or echocardiography, which may show pericardial fluid or collapsed heart chambers, as seen in our patient [2,11]. Nan and colleagues found that FAST did not detect BCI in 3 out of 11 (27%) patients with blunt cardiac rupture; and these 3 patients required further diagnostic tests (i.e., echocardiography, computed tomography, and surgical exploration) to confirm the diagnosis [3]. Accordingly, negative FAST results cannot entirely exclude BCI, and further investigations may be needed in a patient suspected to have BCI.…”

Section: Discussionmentioning

confidence: 85%

“…The mortality rates of BCI range from 27% to 89%; the higher mortality rates were reported in a series with a higher incidence of cardiac arrest upon arrival [1-3, 11, 12]. Although the most common manifestation of BCI is cardiac tamponade; the classical Beck's Triad-muffled heart sounds, jugular venous distention, and hypotensionis rarely seen [2,3]. The presence of unexplained hypotension after blunt torso trauma should prompt suspicion of BCI and cardiac tamponade [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…Although the most common manifestation of BCI is cardiac tamponade; the classical Beck's Triad-muffled heart sounds, jugular venous distention, and hypotensionis rarely seen [2,3]. The presence of unexplained hypotension after blunt torso trauma should prompt suspicion of BCI and cardiac tamponade [2,3]. A diagnosis of BCI can be made rapidly by FAST or echocardiography, which may show pericardial fluid or collapsed heart chambers, as seen in our patient [2,11].…”

Section: Discussionmentioning

confidence: 99%

“…The definitive treatment of blunt cardiac rupture is surgical repair [1][2][3]. The choice of incision can be either median sternotomy, which gives excellent exposure to the heart in relatively stable patients, or left anterolateral thoracotomy, which provides rapid access to the heart and left lung in unstable patients, but may give inadequate exposure to certain parts of the heart (namely, the right atrium and right ventricle) [2].…”

Section: Discussionmentioning

confidence: 99%

“…Blunt cardiac injury (BCI) is an uncommon injury with a reported incidence of 0.02%-2% [1][2][3]. Two life-threatening forms of BCI requiring immediate surgical treatment are free wall rupture and cardiac tamponade [4].…”

mentioning

confidence: 99%

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Damage control surgery in blunt cardiac injury

et al. 2014

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Background: Blunt cardiac injury (BCI) is a rare, but life threatening injury. The treatment of BCI is surgical repair. However, in a BCI patient with hypothermia, acidosis, and coagulopathy, an attempt to control the bleeding completely by surgery alone may not be successful. Damage control principles should be used in this situation. Objective: To study a BCI patient who underwent a successful operation using damage control principles. Methods: We reviewed and analyzed the patient's chart, operative notes and follow up visit records. Review of the literature regarding the issue was also conducted. Results: We report the case of a patient with BCI who developed hypothermia and coagulopathy during surgery. Abbreviated surgical repair was performed with a right pleuropericardial window created to avoid blood accumulation in the pericardial sac. Subsequent aggressive resuscitation was performed in the intensive care unit. We accepted ongoing bleeding through the right chest tubes while correction of hypothermia and coagulopathy was undertaken. The bleeding was gradually stopped once the patient's physiology was restored. Although the patient developed a retained right hemothorax requiring subsequent video-assisted thoracoscopic surgery on the third postoperative week, he recovered uneventfully and was discharged on postoperative day 36. Conclusion:In patients with BCI who develop coagulopathy during surgery, terminating the operation quickly and creating a pleuropericardial window is a possible bailout solution because this can prevent postoperative cardiac tamponade without leaving the chest open. Continue bleeding from the chest tubes is acceptable provided that adequate resuscitation to correct coagulopathy is underway.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%