Five cases of blunt traumatic cardiac rupture: success and failure in surgical management

Abstract

We report five cases of blunt cardiac rupture seen in our hospital during the last 6 years. All these patients sustained blunt chest trauma due to motor vehicle or motorcycle accidents, and all had vital signs on arrival at the emergency department. We suspected cardiovascular injuries from the findings of echocardiography and CT scans, and all five cases were operated on 2-6 h after injury. Four had a median sternotomy, and one had a lateral thoracotomy. During the operations, we found that two patients had pericardium injuries and all five patients had right chamber injuries, which included multiple, ventricle, and large venous injuries in three patients. The tears were repaired using simple suture or ligation techniques for all patients, with cardiopulmonary bypass in three patients. One patient died during the operation, and four patients survived, therefore the survival rate was 80%. We believe that patients with cardiac rupture who are alive when they reach hospital can often be saved by prompt diagnosis and immediate, adequate surgical repairs.

Blunt Cardiac Rupture: A 5-Year NTDB Analysis

“…10 Plain radiography has also proven misleading, with normal findings documented even in the presence of cardiac rupture. 3,15 Although the use of urgent echocardiography has been described, 12,15,17,21,22 formal echocardiography is often not rapidly available. The successful use of invasive diagnostic techniques, such as pericardiocentesis 6,17 and emergent subxiphoid window, 3,9 has also been described in previous series.…”

“…The consequences of a delayed diagnosis are highlighted by the adverse outcomes described after diagnosis by computed tomography, 12,23,24 at subsequent operation for other indications, 3,25 or in a delayed fashion during the hospital stay or even after discharge. 1,21,22,26 -29 Therefore, despite the rare occurrence of BCR, a high index of suspicion should be maintained after blunt chest trauma, because rapid delivery to the operating room for definitive treatment is associated with improved outcomes.…”

Blunt cardiac rupture: A successful experience of echo-guided pericardiocentesis with large bore central vein catheter drainage in the management of traumatic cardiac tamponade and early thoracotomy for cardiorrhaphy

“…11,8 The incidence of BCR is very rare and reported as low as 0.3-0.5% amongst blunt chest trauma. 8 A recent postmortem study disclosed a very low incidence rate in left atrium ruptured.…”

“…10 The overall mortality rate is extremely high (81.3-100%), and more than 50% of patients presenting with vital signs still expire. 11 Martin et al reported 110 BCR patients with prehospital PEA, concluding that the chance of survival diminishes if a patient develops prehospital cardiac arrest or PEA. 9 Clinical manifestations depend on the presence or absence of tear in the pericardium.…”

“…Even in patients presenting with vital signs, the mortality rate is greater than 50%. 11 However, conventional blind subxiphoid pericardiocentesis in the management of cardiac tamponade showed a complication rate of greater than 20% and needle aspiration cannot guarantee that the blood from haemopericardium will be successfully drawn. 5,1 We herein present a patient with the occurrence of PEA, which was caused by blunt atrial rupture-related haemopericardium with cardiac tamponade.…”