Dual chamber cardiac rupture following blunt thoracic trauma

James W Davis

doi:10.31487/j.scr.2019.02.017

Abstract

Introduction: Cardiac rupture following blunt thoracic trauma is rare. When diagnosed, these injuries have a mortality rate approaching 90%. Although there are reports of dual chamber cardiac rupture, there are no documented survivors from this injury. Case Report: A fifty-year-old man presents after high speed motor vehicle crash. On arrival, he was hypotensive with massive right hemothorax. He progressed to asystole but pulse was regained and he went to the operating room. Upon right thoracotomy we encountered a right pericardial laceration and his incision was converted to bilateral thoracotomy (clamshell). He was found to have both right and left atrial rupture. Both injuries were rapidly repaired. The patient survived to discharge neurologically intact. Discussion: Cardiac chamber rupture is rare and often fatal. Survival can occur with dual chamber rupture if swift action is taken and all members of the team work together.

Highlights

Cardiac rupture following blunt thoracic trauma is rare
Upon right thoracotomy we encountered a right pericardial laceration and his incision was converted to bilateral thoracotomy
Data from the National Trauma Data Bank (NTDB) reveals that of all blunt trauma patients presenting to the emergency department, only 0.045% sustained Blunt cardiac rupture (BCR) [1]

Summary

Introduction

Blunt cardiac rupture (BCR) is a rare event. Data from the National Trauma Data Bank (NTDB) reveals that of all blunt trauma patients presenting to the emergency department, only 0.045% sustained BCR [1]. While there have been many case reports, retrospective case series, and NTDB studies of BCR, to our knowledge there are no published cases of survival following a dual chamber cardiac rupture from blunt thoracic injury. This unique case was challenging in its presentation and management. In this process his pulse was lost and cardiopulmonary resuscitation (CPR) was started His FAST exam was negative and of note, he did not have evidence of tamponade and cardiac ultrasound did not reveal pericardial effusion. Dual chamber cardiac rupture following blunt thoracic trauma of blood from his right chest tube after his pulse was regained, he was taken directly to the operating room. The patient made a full neurologic and physical recovery and was discharged home

Findings

Discussion