Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Blunt Traumatic Cardiac Rupture: Single-Institution Experiences over 14 Years

  • Yun, Jeong Hee (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Byun, Joung Hun (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Kim, Sung Hwan (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Moon, Sung Ho (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Park, Hyun Oh (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Hwang, Sang Won (Department of Thoracic and Cardiovascular Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Yong Hwan (Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine)
  • Received : 2016.03.24
  • Accepted : 2016.08.26
  • Published : 2016.12.05
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Abstract

Background: Blunt traumatic cardiac rupture is rare. However, such cardiac ruptures carry a high mortality rate. This study reviews our experience treating blunt traumatic cardiac rupture. Methods: This retrospective study included 21 patients who experienced blunt traumatic cardiac rupture from 1999 to 2015. Every patient underwent surgery. Several variables were compared between survivors and fatalities. Results: Sixteen of the 21 patients survived, and 5 (24%) died. No instances of intraoperative mortality occurred. The most common cause of injury was a traffic accident (81%). The right atrium was the most common location of injury (43%). Ten of the 21 patients were suspected to have cardiac tamponade. Significant differences were found in preoperative creatine kinase-myocardial band (CK-MB) levels (p=0.042) and platelet counts (p=0.004) between the survivors and fatalities. The patients who died had higher preoperative Glasgow Coma Scale scores (p=0.007), worse Trauma and Injury Severity Scores (p=0.007), and higher Injury Severity Scores (p=0.004) than those who survived. Conclusion: We found that elevated CK-MB levels, a low platelet count, and multi-organ traumatic injury were prognostic factors predicting poor outcomes of blunt cardiac rupture. If a patient with blunt traumatic cardiac rupture has these factors, clinicians should be especially attentive and respond promptly in order to save the patient's life.

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References

  1. Bright EF, Beck CS. Nonpenetrating wounds of the heart: a clinical and experimental study. Am Heart J 1935;10:293-321. https://doi.org/10.1016/S0002-8703(35)90312-X
  2. Brathwaite CE, Rodriguez A, Turney SZ, Dunham CM, Cowley R. Blunt traumatic cardiac rupture: a 5-year experience. Ann Surg 1990;212:701-4. https://doi.org/10.1097/00000658-199012000-00008
  3. Kang JK, Yoon YS, Kim HT, Park ID, Soh DM, Lee CJ. Surgical management of traumatic cardiac injury. Korean J Thorac Cardiovasc Surg 2004;37:335-41.
  4. Nan YY, Lu MS, Liu KS, et al. Blunt traumatic cardiac rupture: therapeutic options and outcomes. Injury 2009;40:938-45. https://doi.org/10.1016/j.injury.2009.05.016
  5. Martin TD, Flynn TC, Rowlands BJ, Ward RE, Fischer RP. Blunt cardiac rupture. J Trauma 1984;24:287-90. https://doi.org/10.1097/00005373-198404000-00001
  6. Perchinsky MJ, Long WB, Hill JG. Blunt cardiac rupture: the Emanuel Trauma Center experience. Arch Surg 1995;130:852-6. https://doi.org/10.1001/archsurg.1995.01430080054008
  7. Namai A, Sakurai M, Fujiwara H. Five cases of blunt traumatic cardiac rupture: success and failure in surgical management. Gen Thorac Cardiovasc Surg 2007;55:200-4. https://doi.org/10.1007/s11748-007-0106-x
  8. Fitzgerald M, Spencer J, Johnson F, Marasco S, Atkin C, Kossmann T. Definitive management of acute cardiac tamponade secondary to blunt trauma. Emerg Med Australas 2005;17:494-9. https://doi.org/10.1111/j.1742-6723.2005.00782.x
  9. Fulda G, Brathwaite CE, Rodriguez A, Turney SZ, Dunham CM, Cowley RA. Blunt traumatic rupture of the heart and pericardium: a ten-year experience (1979-1989). J Trauma 1991;31:167-72. https://doi.org/10.1097/00005373-199131020-00003
  10. Swaanenburg JC, Klaase JM, DeJongste MJ, Zimmerman KW, ten Duis HJ. Troponin I, troponin T, CKMB-activity and CKMB-mass as markers for the detection of myocardial contusion in patients who experienced blunt trauma. Clin Chim Acta 1998;272:171-81. https://doi.org/10.1016/S0009-8981(98)00014-X
  11. Nijboer JM. New insights in outcome after major trauma. Groningen: University Library Groningen; 2009.
  12. Guyton AC, Hall JE. Textbook of medical physiology. Philadelphia (PA): Saunders; 2000.

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