Two Cases of Right Atrial Rupture due to Blunt Chest Injury in Teenaged Drivers after Motor Vehicle Accidents

(Department of Cardiovascular Surgery, Nagahama City Hospital, Nagahama, Japan, Department of Cardiovascular Surgery, Kumamoto Central Hospital*, Kumamoto, Japan and Department of Cardiovascular Surgery, Shizuoka General Hospital**, Shizuoka, Japan)

Masatsugu Hamaji Satoshi Kono Masanosuke Ishigami*
Akiyoshi Mikuriya Mitsuru Kitano** Mitsuhiko Matsuda
Cardiac injury following blunt chest trauma requires immediate transportation, correct diagnosis and early surgical treatment. We present 2 cases of rare cardiac rupture, right auricular laceration and multiple ruptures of vena cava, respectively. Case 1: An 18-year-old male driver was transported to a local hospital in a state of shock immediately after a traffic accident. Chest CT demonstrated cardiac tamponade. After temporary hemodynamic improvement by pericardiocentesis, he was referred to our hospital. Since his blood pressure decreased below the measurable threshold in the ICU, he was transferred to the OR after emergency subxiphoid pericardial drainage. On opening the pericardium after full sternotomy, the right atrial appendage laceration was found, about 1cm in length, and was sutured easily without cardiopulmonary bypass or any transfusion. Postoperative recovery was uneventful. Case 2: A 19-year-old male driver was directly transferred in an apneic shock state. Chest CT revealed cardiac tamponade. Full sternotomy was promptly carried out in the ICU after cardiopulmonary resuscitation (CPR) and subxiphoid pericardial drainage. Caval injury was found, 2cm in length, in both the superior vena cava (SVC) and intrapericardial inferior vena cava (IVC). His circulatory state was restored after the repair of these caval injuries without cardiopulmonary bypass; however, he died from severe brain damage postoperatively. In summary, blunt rupture of the right heart could be saved by prompt transport with airway assist, pericardial drainage, and proper surgery.
@Jpn. J. Cardiovasc. Surg. 35: 295-298 (2006)