Cardiac rupture following blunt trauma

Abstract

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%.

The Double Jeopardy of Blunt Thoracoabdominal Trauma

“…31 A more recent review found the reported incidence in patients presenting to the hospital to range from 0.05% to 0.5% and documented rare reports of survivability with early recognition and treatment, even in the setting of complex, multisystem trauma. 32 No survivors of this injury were observed in our series.…”

Blunt Rupture of Left Ventricle Diagnosed Using Two Phase Contrast Enhanced CT: A Case Report

“…While the CT image can only display a hemopericardium and sometimes its compressive nature, its origin cannot be defined. In rare cases, however, an abnormal contrast material leak can be observed (3)(4)(5). Arterial…”

“…Detection of cardiac rupture relies mainly on clinical suspicion and echocardiography, especially transesophageal echocardiography (2,3). In rare cases, leaking of the contrast material in hemopericardium patients can be detected on the initial CT examination, allowing early diagnosis of cardiac rupture (3)(4)(5).…”

Blunt Polytrauma: Evaluation with 64-Section Whole-Body CT Angiography

“…However, they deserve mention because of the likelihood of a catastrophic outcome and the need for immediate surgical intervention when present. These injuries may result from massive compression of the chest, traction at fixed points of attachment, or direct penetration by fractured ribs or sternum (57).…”