Cardiac Rupture From Blunt Trauma With Atrial Septal Defect

Abstract

A review of the literature disclosed 63 survivors of cardiac chamber rupture from blunt trauma, with no mention of associated atrial septal defect. I treated a 17-year-old girl and a 33-year-old man who survived cardiac rupture from motor vehicle accidents, both of whom were discovered postoperatively on echocardiography to have atrial septal defects.

Traumatic atrial septal defect diagnosed by bedside point-of-care ultrasound

“…Alternatively, the premise behind traumatic atrial septal injury is an acute force against a variable intracardiac volume which induces enough pressure change to overcome the compliance of a particular myocardial structure [7] . It is postulated that the timing of extrinsic force with cardiac cycle phase, coupled with direction of chest compression are important variables with respect to the subsequent cardiac injury sustained [ 2 , 7 , 9 , 13 , 14 ]. The atria may be most vulnerable when they are maximally distended – namely with the ventricles in systole, the A-V valves closed, and the patient in deep inspiration with maximal venous return [11] (i.e., in an unexpected vehicle impact).…”

“…Traumatic atrial septal defects (ASD) have generally been understudied, with many of the previously reported cases having occurred alongside ventricular septal defects (VSD) [1] . It has been proposed that blunt trauma may induce an atrial septal defect (ASD) through a few mechanisms [2] . Forces directed at the patient's abdomen may lead to increased intracardiac pressures [2] .…”

“…It has been proposed that blunt trauma may induce an atrial septal defect (ASD) through a few mechanisms [2] . Forces directed at the patient's abdomen may lead to increased intracardiac pressures [2] . Additionally, the heart may be compressed between the sternum and vertebral bodies, leading to chamber or septal rupture [2] .…”

“…Forces directed at the patient's abdomen may lead to increased intracardiac pressures [2] . Additionally, the heart may be compressed between the sternum and vertebral bodies, leading to chamber or septal rupture [2] . Acceleration and deceleration forces could potentially induce shearing forces which may lead to tearing of the septum or chamber walls [2] .…”

“…Additionally, the heart may be compressed between the sternum and vertebral bodies, leading to chamber or septal rupture [2] . Acceleration and deceleration forces could potentially induce shearing forces which may lead to tearing of the septum or chamber walls [2] . Blunt trauma continues to be a prevalent occurrence, occasionally causing cardiac lesions and in these cases, prompt diagnosis can be directly linked to outcomes and overall survival [3] .…”