Survival after left ventricular rupture following blunt chest injury

Successful Operative Repair of Delayed Left Ventricle Rupture From Blunt Trauma

A 21-year-old female was found to have an enlarging pericardial effusion 10 days after a 40-foot fall. Initial cardiac evaluation was negative. Ten days after presentation she developed hemodynamic compromise and chest computed tomography was concerning for cardiac rupture. The patient was taken to the operating room where the ruptured posterior ventricle was repaired, perforation in the P1 leaflet was identified and the mitral valve was replaced. The patient survived. To our knowledge, this is the first report of survival after delayed presentation of atrioventricular rupture at the level of the mitral valve.

Pectus excavatum in blunt chest trauma: a case report

Introduction

Blunt cardiac rupture is an exceedingly rare injury.

Case presentation

We report a case of blunt cardiac trauma in a 43-year-old Caucasian German mother with pectus excavatum who presented after a car accident in which she had been sitting in the front seat holding her two-year-old boy in her arms. The mother was awake and alert during the initial two hours after the accident but then proceeded to hemodynamically collapse. The child did not sustain any severe injuries. Intraoperatively, a combined one-cm laceration of the left atrium and right ventricle was found.

Conclusion

Patients with pectus excavatum have an increased risk for cardiac rupture after blunt chest trauma because of compression between the sternum and spine. Therefore, patients with pectus excavatum and blunt chest trauma should be admitted to a Level I Trauma Center with a high degree of suspicion.

Cardiac rupture following blunt trauma

Cardiac rupture is the most extreme manifestation of blunt cardiac injury. In the first half of the 20th century this lesion was uniformly fatal. Since the first successful post-traumatic cardiorrhaphy by Desforges in 1955, multiple case reports and retrospective reviews have documented successful operative repair and survival of patients with this injury. Despite these successes, blunt cardiac rupture remains associated with a high mortality rate. The rarity of this condition and the heterogeneity of the literature make determination of exact epidemiologic data difficult. The classic clinical presentation is not universal and a subset of patients may present asymptomatically. Rapid transportation to medical care, accurate timely diagnosis and emergent operative intervention are essential for successful outcome. The use of ultrasonography in the trauma bay is a key component of early identification of these injuries. Specific outcome factors associated with survival are difficult to determine and even in those who survive to medical attention mortality rates remain as high as 60—90%.

Myocardial contusion culminating in a ruptured pseudoaneurysm of the left ventricle--a case report

Blunt chest trauma continues to be one of the most common injuries at all ages. Trauma in general is the leading cause of death in the young to middle-aged segment of our population. Blunt chest injury is said to occur in more than one third of all motor vehicle accidents. Myocardial contusion is the most frequent cardiac injury resulting from blunt chest trauma. Autopsy studies indicate that cardiac trauma was directly associated with death in approximately 10% of cases suffering blunt chest injury. Aneurysm formation as a sequela of blunt cardiac trauma is a rare entity and pseudoaneurysm formation is considerably more rare. A case of myocardial contusion resulting in myocardial necrosis, rupture of the ventricle, and pseudoaneurysm formation with subsequent rupture and sudden death is presented.