Abstract
Background: Pericardial rupture is a rare diagnosis, usually occurring secondary to high energy blunt force trauma, which can result in subluxation of the heart. Aim: To determine a suitable method for repair of a pericardial defect post traumatic pericardial rupture. Case: We present a 55-year-old male who was found to have a large pericardial defect intra-operatively while undergoing an elective Ross procedure. The defect was repaired with a Gore-Tex membrane. The patient underwent revision sternotomy and repair of the pericardium due to inadequate laxity of the repaired pericardium resulting in hemodynamic instability. Conclusion: Synthetic membranes, such as Gore-Tex membranes, can be used successfully for repair of large pericardial defects but care must be taken to prevent undue tension secondary to taut repair, resulting in hemodynamic compromise.
Highlights
Pericardial rupture secondary to blunt trauma was first described in the literature in 1864 [1] and is usually associated with high energy incidents, often with a deceleration mechanism and significant mortality [2] [3] [4]
Pericardial rupture is a rare diagnosis, usually occurring secondary to high energy blunt force trauma, which can result in subluxation of the heart
Case: We present a 55-year-old male who was found to have a large pericardial defect intra-operatively while undergoing an elective Ross procedure
Summary
Pericardial rupture secondary to blunt trauma was first described in the literature in 1864 [1] and is usually associated with high energy incidents, often with a deceleration mechanism and significant mortality [2] [3] [4]. The most significant incident was in 1996 where the patient was ejected over the handlebars of the motorbike at high speeds, sustaining blunt trauma to the chest His thoracic injuries included right and left sided rib fractures and hemothorax. Pre-operative chest radiographs from October 2020 showed long standing elevation of the left hemi-diaphragm and bilateral healed rib fractures (Figure 1(A)). Post-operative chest radiographs revealed a moderate sized left basal pleural effusion and a stable elevation of the left hemidiaphragm, with the heart seated further towards the right side (Figure 4) compared to his pre-operative state (Figure 1(B)). A post-operative cardiac CT with contrast revealed patency of the great vessels, a small pericardial and bilateral pleural effusion with adjacent atelectasis (Figure 5) Following his second procedure, the patient progressed uneventfully.
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