Korean J Crit Care Med.  2015 Feb;30(1):27-30. 10.4266/kjccm.2015.30.1.27.

Cardiac Rupture of the Junction of the Right Atrium and Superior Vena Cava in Blunt Thoracic Trauma

• Byun CS
• Park IH
• Kim TH
• Lee E
• Oh JH

• KMID: 2227697
• DOI: http://doi.org/10.4266/kjccm.2015.30.1.27

Abstract

Cardiac rupture following blunt thoracic trauma is rarely encountered, since it commonly causes death at the scene. With advances in critical care, blunt cardiac rupture has been successfully treated with well-organized team approach including an emergency physician, anesthesiologist, and cardiac surgeon. We encountered a patient with blunt cardiac rupture of the junction of the superior vena cava and right atrium that extended 7 cm to the right ventricular junction. The patient was successfully resuscitated after a closed thoracostomy and pericardiocentesis with fluid loading. Cardiac injury was repaired via mid-sternotomy without cardiopulmonary bypass. The patient recovered without complications and was discharged on the 7th day after surgery.

Keyword

heart injuries; heart rupture; pericardiocentesis; trauma, blunt injuries

MeSH Terms

Cardiopulmonary Bypass
Critical Care
Emergencies
Heart Atria*
Heart Injuries
Heart Rupture*
Humans
Pericardiocentesis
Thoracostomy
Vena Cava, Superior*

Figure

• 

  Fig. 1. The eFAST showed cardiac tamponade resulting from a large hematoma in the pericardium (red arrow). eFAST: extended focused assessment with sonography for trauma.

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  Fig. 2. Chest radiography was almost normal, except for the slightly enlarged right heart. The right chest tube was used to treat traumatic pneumothorax.

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  Fig. 3. Initial resuscitation with subxiphoid pericardial drainage was performed in emergency room under echocardiography.

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  Fig. 4. The cardiac injury included rupture of the junction of the superior vena cava and the right atrium, with a deep 7 cm laceration into right ventricular junction (black arrow).

Reference

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