Traumatic Pericardial Rupture With Cardiac Herniation

Lindenmann, Joerg; Matzi, Veronika; Neuboeck, Nicole; Porubsky, Christian; Ratzenhofer, B; Maier, Andrea B.; Smolle‐Juettner, Freyja‐Maria

doi:10.1016/j.athoracsur.2009.10.048

Cited by 19 publications

(17 citation statements)

References 7 publications

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“…Referring to the operative approach, some surgeons favor a median sternotomy, 24,25 but others use an anterior thoracotomy. 10,23 In our experience, most BCIs could be managed via an anterolateral thoracotomy, and if necessary, the sternum was transected. Many surgeons have observed that the injured site of BCI is mainly located on the anterior side of the heart.…”

Section: Discussionmentioning

confidence: 91%

“…8,9 There are five types of high-incidence injury: steering wheel injury, sternal fracture, anterior flail chest, bilateral BTI, and catercorner injuries (when chest and abdominal injuries are not on the same side). Three signs are important: 1) Beck's triad is evidence of cardiac tamponade; 2) shock abruptly resulting from a change in patient posture reveals pericardial herniation and strangulation 8,10 ; and 3) angina pectoris implies coronary artery injury, which is called TACS. Angina pectoris is differentiated from the pain of sternal or costal fracture by the simultaneous appearance of heart throbbing, pallor, changes in pulse, BP changes, ECG changes, and relief gained by the administration of nitroglycerine.…”

Section: Discussionmentioning

confidence: 99%

“…In pericardial herniation, concomitant myocardial contusion seems to be the rule. 10 The in-hospital mortality rate of pericardial herniation can be as high as 64 per cent. 19 Therefore, early recognition and rapid operation are very important.…”

Section: Discussionmentioning

confidence: 99%

“…After replacement of the herniated heart, pericardial closure may be impossible because of cardiac dilation, and a mesh patch is used for closure of the rupture. 10 Otherwise, intrapericardial phrenic hernia also requires urgent thoracotomy. As the operation is performed via the chest cavity, only pericardial window drainage behind the phrenic nerve with chest tube drainage is performed instead of placement of the pericardial drainage tube.…”

Section: Discussionmentioning

confidence: 99%

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Blunt Cardiac Injury: A Single-Center 15-Year Experience

Jin-mou

Gong-bin

et al. 2020

The American Surgeon

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In recent years, the incidence of blunt cardiac injury (BCI) has increased rapidly and is an important cause of death in trauma patients. This study aimed to explore early diagnosis and therapy to increase survival. All patients with BCI during the past 15 years were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. The patients were divided into two groups according to the needs of their condition—nonoperative (Group A) and operative (Group B). Comparisons of the groups were performed. A total of 348 patients with BCI accounted for 18.3 per cent of 1903 patients with blunt thoracic injury. The main cause of injury was traffic accidents, with an incidence of 48.3 per cent. In Group A (n = 305), most patients sustained myocardial contusion, and the mortality was 6.9 per cent. In Group B (n = 43), including those with cardiac rupture and pericardial hernia, the mortality was 32.6 per cent. Comparisons of the groups regarding the shock rate and mortality were significant ( P < 0.01). Deaths directly resulting from BCI in Group B were greater than those in Group A ( P < 0.05). In all 348 patients, the mortality rate was 10.1 per cent. When facing a patient with blunt thoracic injury, a high index of suspicion for BCI must be maintained. To manage myocardial contusion, it is necessary to protect the heart, alleviate edema of the myocardium, and control arrhythmia with drugs. To deal with those requiring operation, early recognition and expeditious thoracotomy are essential.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Blunt Cardiac Injury: A Single-Center 15-Year Experience

Jin-mou

Gong-bin

et al. 2020

The American Surgeon

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“…Cardiac herniation following pericardial rupture is a rare but potentially fatal consequence of blunt trauma. Previous case reports describe how the diagnosis is often delayed despite signs on initial imaging [8]. Surgical intervention either via a thoracotomy or sternotomy and repair with sutures or patch is described with good clinical outcomes; therefore, early intervention and management is the key in reducing morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Cardiac Herniation Presenting as Dextrocardia: A Case Report

Holt

Fraser²,

Richards³

et al. 2017

IJCR

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Background: Cardiac herniation is a rare but significant complication of blunt traumatic pericardial rupture most commonly occurring as a result of high-energy road traffic accidents. Case reports to date highlight delays in diagnosis and management as well as high rates of morbidity and mortality. Case presentation: A 19 year old motorcyclist was brought into the emergency department via helicopter following a road traffic accident with severe injuries to his chest, abdomen and limbs. Following a period of haemodynamic instability, an urgent chest radiograph demonstrated new dextrocardia compared to his admission radiograph. A diagnosis of cardiac herniation was confirmed and the patient underwent emergency surgery with a mesh repair within 12 hours of his initial presentation. He made a full recovery from a cardiothoracic perspective and was well at follow up three months after discharge. Conclusions: Pericardial rupture and cardiac herniation should be considered urgently in the context of abnormal cardiac anatomy on imaging following blunt trauma. Here, we describe a case of prompt identification and definitive surgical intervention for cardiac herniation. The diagnosis was made following a chest radiograph showing new dextrocardia and the patient had a good clinical outcome.

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