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      Patient With Missed Right Ventricular Rupture From Blunt Trauma Remains Hemodynamically Stable for 3 Days

      case-report

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          Abstract

          Cardiac chamber rupture from blunt trauma is rare but can be fatal. Surprisingly, in some subsets of patients, it can be subtle and rather easily missed. Rapid recognition and management are essential. Percutaneous closure can be successful in iatrogenic chamber perforation (during pericardiocentesis) but possibly not in traumatic chamber rupture. ( Level of Difficulty: Intermediate.)

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          Blunt cardiac rupture: a 5-year NTDB analysis.

          Pedro Teixeira, Kenji Inaba, Didem Oncel … (2009)
          Because of its rarity and high rate of mortality, traumatic blunt cardiac rupture (BCR) has been poorly studied. The objective of this study was to use the National Trauma Data Bank to review the epidemiology and outcomes associated with traumatic BCR. After approved by the institutional review board, the National Trauma Data Bank (version 5.0) was queried for all BCR occurring between 2000 and 2005. Demographics, clinical injury data, interventions, and outcomes were abstracted for each patient. Statistical analysis was performed using an unpaired Student's t test or Mann-Whitney U test to compare means and chi analysis to compare proportions. Stepwise logistic regression analysis was performed to identify independent predictors of inhospital mortality. Of 811,531 blunt trauma patients, 366 (0.045%) had a BCR of which 334 were available for analysis, with the mean age of 45 years, 65% were men, and their mean Injury Severity Score was 58 +/- 19. The most common mechanism of injury was motor vehicle collision (73%), followed by pedestrian struck by auto (16%), and falls from height (8%). Twenty-one patients (6%) died on arrival and 140 (42%) died in the emergency room. The overall mortality for patients arriving alive to hospital was 89%. Of the patients surviving to operation, 42% survived >24 hours of which 87% were discharged. Survivors were significantly younger (39 vs. 46 years, p = 0.04), had a lower Injury Severity Score (47 vs. 56, p = 0.02), higher Glasgow Coma Scale (10 vs. 6, p or=90 mm Hg (p = 0.01). Nevertheless, none of these factors was found to be an independent risk factor for mortality. BCR is an exceedingly rare injury, occurring in 1 of 2400 blunt trauma patients. In patients arriving alive to hospital, traumatic BCR is associated with a high mortality rate, however, is not uniformly fatal.
          Article 0 comments Cited 24 times – based on 0 reviews     Review now
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            Blunt cardiac trauma: lessons learned from the medical examiner.

            Edwin S L Chan, Pedro Teixeira, David Plurad … (2009)
            The objective of this study was to analyze autopsy findings after blunt traumatic deaths to identify the incidence of cardiac injuries and describe the patterns of associated injuries. All autopsies performed by the Los Angeles County Forensic Medicine Division for blunt traumatic deaths in 2005 were retrospectively reviewed. Only cases that underwent a full autopsy including internal examination were included in the analysis. The study population was divided into two groups according to the presence or absence of a cardiac injury and compared for differences in baseline characteristics and types of associated injuries. Of the 881 fatal victims of blunt trauma received by the Los Angeles County Forensic Medicine Division, 304 (35%) underwent a full autopsy with internal examination and were included in the analysis. The mean age was 43 years +/- 21 years, patients were more often men (71%) and were intoxicated in 39% of the cases. The most common mechanism was motor vehicle collision (50%), followed by pedestrian struck by auto (37%), and 32% had a cardiac injury. Death at the scene was significantly more common in patients with a cardiac injury (78% vs. 65%, p = 0.02). The right chambers were the most frequently injured (30%, right atrium; 27%, right ventricle). Among the 96 patients with cardiac injuries, 64% had transmural rupture. Multiple chambers were ruptured in 26%, the right atrium in 25%, and the right ventricle in 20% of these patients. Patients with cardiac injuries were significantly more likely to have other associated injuries: thoracic aorta (47% vs. 27%, p = 0.001), hemothorax (81% vs. 59%, p < 0.001), rib fractures (91% vs. 71%, p < 0.001), sternum fracture (32% vs. 13%, p < 0.001), and intra-abdominal injury (77% vs. 48%, p < 0.001) compared with patients without cardiac injury. Of the 96 patients with a cardiac injury, 78% died at the scene of the crash and 22% died en route or at the hospital. Cardiac injury is a common autopsy finding after blunt traumatic fatalities, with the majority of deaths occurring at the scene. Patients with cardiac injuries are at significantly increased risk for associated thoracic and intra-abdominal injuries.
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              Multi-detector row computed tomography and blunt chest trauma.

              Ivan Pedrosa, José Tasende, Amelia Sparano … (2008)
              Blunt chest trauma is a significant source of morbidity and mortality in industrialized countries. The clinical presentation of trauma patients varies widely from one individual to another and ranges from minor reports of pain to shock. Knowledge of the mechanism of injury, the time of injury, estimates of motor vehicle accident velocity and deceleration, and evidence of associated injury to other systems are all salient features to provide for an adequate assessment of chest trauma. Multi-detector row computed tomography (MDCT) scanning and MDCT-angiography are being used more frequently in the diagnosis of patients with chest trauma. The high sensitivity of MDCT has increased the recognized spectrum of injuries. This new technology can be regarded as an extremely valuable adjunct to physical examination to recognize suspected and unsuspected blunt chest trauma.
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                Author and article information

                Contributors
                Ali Dahhan
                Journal
                Journal ID (nlm-ta): JACC Case Rep
                Journal ID (iso-abbrev): JACC Case Rep
                Title: JACC Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2666-0849
                Publication date PMC-release: 26 September 2023
                Publication date Collection: 01 November 2023
                Publication date (Electronic): 26 September 2023
                Volume: 25
                Electronic Location Identifier: 102034
                Affiliations
                [a ]Department of Internal Medicine, HCA Healthcare–HCA Florida Bayonet Point/University of South Florida Morsani, Hudson, Florida, USA
                [b ]Division of Cardiology, HCA Healthcare–HCA Florida Bayonet Point/University of South Florida Morsani, Hudson, Florida, USA
                [c ]Department of Cardiothoracic Surgery, HCA Healthcare–HCA Florida Bayonet Point/University of South Florida Morsani, Hudson, Florida, USA
                Author notes
                [∗ ] Address for correspondence: Dr Ali Dahhan, Division of Cardiology, HCA Florida Bayonet Point Hospital, 14000 Fivay Road, Hudson, Florida 34667, USA. ali_dahhan08@ 123456yahoo.com
                Article
                Publisher Item ID: S2666-0849(23)00368-6 Publisher ID: 102034
                DOI: 10.1016/j.jaccas.2023.102034
                PMC ID: 10715929
                PubMed ID: 38094212
                SO-VID: 8172921e-4683-43da-a495-e149ebbab1f2
                Copyright © © 2023 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 24 March 2023
                Date revision received : 9 May 2023
                Date accepted : 11 May 2023
                Categories
                Subject: Case Report
                Subject: Clinical Case

                Keywords: blunt trauma,cardiac chamber rupture,cardiac injury,percutaneous closure,right ventricular perforation,right ventricular rupture,surgical repair
                Data availability:
                Keywords: blunt trauma, cardiac chamber rupture, cardiac injury, percutaneous closure, right ventricular perforation, right ventricular rupture, surgical repair

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