Case reports of atrial and pericardial rupture from blunt cardiac trauma

Abstract

BackgroundBlunt cardiac trauma is diagnosed in less than 10% of trauma patients and covers the range of severity from clinically insignificant myocardial contusions to lethal multi-chamber cardiac rupture. The most common mechanisms of injury include: motor vehicle collisions (MVC), pedestrians struck by motor vehicles and falls from significant heights. A severe complication from blunt cardiac trauma is cardiac chamber rupture with pericardial tear. It is an exceedingly rare diagnosis. A retrospective review identified only 0.002% of all trauma patients presented with this condition. Most patients with atrial rupture do not survive transport to the hospital and upon arrival diagnosis remains difficult.Case presentationWe present two cases of atrial and pericardial rupture. The first case is a 33-year-old female involved in a MVC, who presented unresponsive, hypotensive and tachycardic. A left sided hemothorax was diagnosed and a chest tube placed with 1200 mL of bloody output. The patient was taken to the OR emergently. Intraoperatively, a laceration in the right pericardium and a 3 cm defect in the anterior, right atrium were identified. Despite measures to control hemorrhage and resuscitate the patient, the patient did not survive.The second case is a 58-year-old male involved in a high-speed MVC. Similar to the first case, the patient presented unresponsive, hypotensive and tachycardic with a left sided hemothorax. A chest tube was placed with 900 mL of bloody output. Based on the output and ongoing resuscitation requirements, the patient was taken to the OR. Intraoperatively, a 15 cm anterior pericardial laceration was identified. Through the defect, there was brisk bleeding from a 1 cm laceration on the left atrial appendage. The injury was debrided and repaired using a running 3–0 polypropylene suture over a Satinsky clamp. The patient eventually recovered and was discharged home.ConclusionsWe present two cases of uncontained atrial and pericardial rupture from blunt cardiac trauma. Contained ruptures with an intact pericardium present as a cardiac tamponade while uncontained ruptures present with hemomediastinum or hemothorax. A high degree of suspicion is required to rapidly diagnose and perform the cardiorrhaphy to offer the best chance at survival.

A successful off-pump cardiac repair following blunt cardiac rupture – A case report

“…The most common cause of cardiac rupture is road traffic injuries- especially with a frontal collision in high-speed motor vehicle [ 6 ]. The presentation of cardiac injuries after blunt chest trauma varies from a clinically insignificant myocardial contusion to full-thickness cardiac rupture [ 5 ]. Most of the patients with cardiac rupture die because of cardiac tamponade or severe bleeding [ 5 ].…”

“…75 out of 1121 patients were found to have a cardiac rupture in the post-mortem report [ 4 ]. Frontal collisions like a crushing force against the steering wheel appear to be the leading cause of cardiac rupture [ 4 , 5 ]. Besides blunt cardiac rupture has high mortality with a variable presentation in the emergency department, thus making diagnosis of this entity more arduous [ 5 ].…”

“…Frontal collisions like a crushing force against the steering wheel appear to be the leading cause of cardiac rupture [ 4 , 5 ]. Besides blunt cardiac rupture has high mortality with a variable presentation in the emergency department, thus making diagnosis of this entity more arduous [ 5 ]. Ours is a case of blunt cardiac rupture with open tibia fracture and compartment syndrome of leg, which was successfully managed by the trauma team.…”

Forensic characteristics of chest injuries among subjects who died in road traffic accidents

“…In cases of myocardial rupture, death occurs within a few moments, and the diagnosis is most frequently set during autopsy 39 . According to the results of this study, aortic rupture was the most frequent injury of intrathoracic organs in motor vehicle drivers and front-seat passengers.…”

“I Tripped and Broke My Heart”: A Case Report of Right Atrial Rupture

“…Although cases of RA rupture have been reported to occur from falls, these were sustained from significant heights with high impact velocities and associated extracardiac trauma, such as pelvic fractures, arterial ruptures, and mesenteric injury. 3,5,6 Most reported cases of IRAR occur from blunt chest trauma from motor vehicle accidents, with the direct impact to the chest as the mechanism for rupture. 3 The mechanism for IRAR in our case is unclear but is likely related to hydraulic and deceleration forces potentially occurring at a particular moment in the cardiac cycle during the patient's fall.…”