Blunt Traumatic Cardiac Rupture A 5-Year Experience

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Abstract
Blunt traumatic cardlac rupture Is associated with a high rate of mortality. A review of the computerized trauma registry (1983 to 1988) identified 32 patients with this injury (ages 19 to 65 years; mean age, 39.5 years; 21 men and 11 women). Twentyone patients (65.6%) were injured in vehicular crashes, 3 (9.4%) in pedestrian accidents, 3 (9.4%) to motorcycle accidents; 3 (9.4%) sustained crush injury; 1 (3.1%) was injured by a fall; and 1 (3.1%) was kicked in the chest by a hone. Anatomic injuries included right atrial rupture (13 [40.6%]), left atrial rapture (8 (25%)), right ventricular rupture (10 [31.3%]), left ventricular rapture (4 [12.5%]), and rupture of two cardiac chambers (3 [9.4%]). Diagnosis was made by thoracotomy in all 20 patients presenting in cardiac arrest. In the remaining 12 patients, the diagnosis was established to seven by emergency left anterolateral thoracotomy and to five by subxypnold pericardial window. Seven of these 12 patients (58.3%) had clinical cardiac tamponade and significant upper torso cyanosis. The mean Injury Severity Score (ISS), Trauma Score (TS), and Glasgow Coma Scale (GCS) score were 33.8, 13.2, and 14.3, respectively, among survivors and 51.5, 8.3, and 7.0 for nonsurvivors. The overall mortality rate was 81.3% (26 of 32 patients), the only survivors being those presenting with vital signs (6 of 12 patients |50%1). All patients with rupture of two cardiac chambers or with ventricular rapture died. The mortality rate from myocardial rapture is very high. Rapid prehospital transportation, a high index of suspicion, and prompt surgical Intervention contribute to survival In these patients.

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