A Report of Three Patients Surviving Near- Fatal Blunt Cardiac Rupture
Keywords:Blunt cardiac rupture, Cardiac tamponade
Blunt cardiac rupture is a rare condition that has a high mortality rate without prompt treatment. This paper reports three patients who survived blunt cardiac rupture, and a literature review was conducted as a reference for further management of this condition. The first patient was a man who sustained a motor-vehicle accident. Upon arrival, he appeared hypotensive and was found to have bilateral pleural effusion and cardiac tamponade with elevated cardiac enzymes. Bilateral chest tubes were inserted. He was brought to the operating room and went into cardiac arrest. Resuscitative thoracotomy was performed, as well as a definitive repair of the cardiac injury. The patient recovered and was discharged. The second patient was a woman, also in a motor-vehicle accident. She appeared hypotensive at the emergency department, where fractured ribs, a pneumothorax, and cardiac tamponade were detected. Chest tube insertion was performed and the patient taken to the operating room where definitive repair was done. She developed a clotted hemothorax for which a thoracotomy was performed to remove the blood clot. She recovered well and was discharged from the hospital. The last patient was a man who fell 7 meters. He had hypotension upon arrival as well as cardiac tamponade. He was brought to the operating room for definitive repair and recovered well and was subsequently discharged. All patients had multiple associated injuries. In conclusion, blunt cardiac rupture is a rare condition and difficult to diagnose. The mortality rate is high, but with prompt management, patients who survived to the hospital may have good outcomes. Prehospital management is also crucial.
1. Yousef R, Carr JA. Blunt cardiac trauma: a review of the current knowledge and management. Ann Thorac Surg 2014 Sep;98:1134-40.
2. Martin TD, Flynn TC, Rowlands BJ, Ward RE, Fischer RP. Blunt cardiac rupture. J Trauma 1984 Apr;24:287-90.
3. Sliker CW, Mirvis SE, Shanmuganathan K, Meyer CA. Blunt cardiac rupture: value of contrast-enhanced spiral CT. Clin Radiol. 2000 Oct;55:805-8.
4. Mikhael F, El-Chami, Nicholson W, Helmy T. Blunt cardiac trauma. Ulus Travma Acil Cerrahi Derg 2008 ;35:127-133.
5. Akar İ, İnce İ, Aslan C, Çeber M, Kaya İ. Left atrial rupture due to blunt thoracic trauma. Ulus Travma Acil Cerrahi Derg 2015 Jul;21:303-5.
6. Salooja MS, Singla M, Srivastava A, Mukherjee KC. Isolated tear in left atrial appendage due to blunt trauma chest: A rare case report. J Saudi Heart Assoc 2013 Apr;25:95-7.
7. Nan YY, Lu MS, Liu KS, et al. Blunt traumatic cardiac rupture: therapeutic options and outcomes. Injury 2009 Sep;40:938-45.
8. Wang Q, Yang L, Zhang Y, Yao Y, He H, Wang Z. Forensic-Pathological Analysis of Blunt Cardiac Rupture Involving the Relationship between Injury and Disease: 2 Cases Report and Review of the Literature. forensic medicine and anatomy research 2016; 4:23-28.
9. Teixeira PG , Inaba K, Oncel D, et al. Blunt cardiac rupture: a 5-year NTDB analysis. J Trauma 2009 ;67:788-91
10. Brathwaite CE, Rodriguez A, Turney SZ, Dunham CM, Cowley R. Blunt Traumatic Cardiac Rupture. Ann Sur 1990;212:701-704
11. Ball CG, Peddle S, Way J, Mulloy RH, Nixon JA, Hameed SM. Blunt cardiac rupture: isolated and asymptomatic. J Trauma 2005 ;58:1075-7.
12. Fedakar R, Türkmen N, Durak D, Gündoğmuş UN. Fatal traumatic heart wounds: review of 160 autopsy cases. Isr Med Assoc J 2005 ;7:498-501.
13. Kritayakirana K, Sriussadaporn S, Pak-Art R, Prichayudh S, Samorn P, Sriussadaporn S. Cardiac trauma: has survival improved? A university hospital experience in Bangkok, Thailand. J Med Assoc Thai 2013;96(2):196-202.
14. Marsh RH, Levine AC, Noble VE, Brown FM, Nadel ES. Case Presentations of the Harvard Affiliated Emergency Medicine Residencies. J Emerg Med 2010;39:337-340.
15. Leavitt BJ, Meyer JA, Morton JR, Clark DE, Herbert WE, Hiebert CA. Survival following non penetrating traumatic rupture of cardiac chambers. Ann Thorac Surg 1987;44:532-5.
16. Ryu DW, Lee SY, Lee MK. Rupture of the left atrial roof due to blunt trauma. Interact Cardiovasc Thorac Surg 2013;17:912-3.
17. Al Ayyan M, Aziz T, El Sherif A, Bekdache O. Blunt cardiac injury: case report of salvaged traumatic right atrial rupture. Ulus Travma Acil Cerrahi Derg 2015;21:527-30.
18. Alameddine AK, Alimov VK, Alvarez C, Rousou JA. Unexpected traumatic rupture of left atrium mimicking aortic rupture. J Emerg Trauma Shock 2014 ;7:310-2.
19. Byun CS, Park H, Park H, Kim TH, Lee E, Oh JH, Cardiac Rupture of the Junction of the Right Atrium and Superior Vena Cava in Blunt Thoracic Trauma. journal Korean Journal of Critical Care Medicine 2015;30:27-30.
20. McKeown PP, Rosemurgy A, Conant P. Blunt traumatic rupture of pulmonary vein, left atrium, and bronchus. Ann Thorac Surg 1991 ;52:1171-2.
21. Podboy MM, A Case of Blunt Cardiac Rupture.Air Medical Journal 2003;22:41-43.
22. Calhoon JH, Hoffmann TH, Trinkle JK, Harman PK, Grover FL. Management of blunt rupture of the heart. J Trauma 1986;26:495-502.
23. Sybrandy KC, Cramer MJ, Burgersdijk C. Diagnosing cardiac contusion: old wisdom and new insights. Heart 2003 ;89:485-9.
24. Clancy K, Velopulos C, Bilaniuk, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care surg 2012;73:s301-s306.
25. Orlando Regional Medical Center. Blunt cardiac trauma. Available at: www.surgicalcriticalcare.net/Guidelines/Blunt%20Cardiac%20Trauma%202016.pdf. Accessed Dec 27,2019
26. May AK, Patterson MA, Rue LW 3rd, Schiller HJ, Rotondo MF, Schwab CW. Combined blunt cardiac and pericardial rupture: review of the literature and report of a new diagnostic algorithm. Am Surg 1999;65:568-74.
27. Helling TS, Duke P, Beggs CW, Crouse LJ. A prospective evaluation of 68 patients suffering blunt chest trauma for evidence of cardiac injury. J Trauma 1989 ;29:961-5.
28. Oizumi H, Suzuki K, Hoshino H, Tatsumori T, Ichinokawa H. A case report: hemothorax caused by rupture of the left atrial appendage. Surg Case Rep 2016 ;2:142.
29. Pinni S, Kumar V, Dharap SB. Blunt Cardiac Rupture: A Diagnostic Challenge. J Clin Diagn Res 2016;10:27-28.
30. Henderson VJ, Smith RS, Fry WR, et al. Cardiac injuries: analysis of an unselected series of 251 cases. J Trauma 1994;36:341-8.
How to Cite
Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.