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Ann Thorac Surg 1999;67:1274-1276
© 1999 The Society of Thoracic Surgeons

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Original Articles

Blunt cardiac rupture: the utility of emergency department ultrasound

^a Division of Cardiothoracic Surgery, Department of Surgery, Grady Hospital, Emory University School of Medicine, Atlanta, Georgia, USA

Accepted for publication October 22, 1998.

Address reprint requests to Dr Panagiotis Symbas, Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, 69 Butler St, Atlanta, GA 30303

Background. Rupture of the heart is usually a fatal injury in patients sustaining blunt trauma. Those arriving in the emergency department alive can be saved with prompt diagnosis and treatment.

Methods. We describe the cases of 4 consecutive patients with rupture of the free cardiac wall whom we treated at Grady Hospital. Two had a tear of the right ventricle, 1 had a tear of the right atrium, and 1 had two tears of the left atrium. All patients were involved in motor vehicle accidents. The diagnosis was made by ultrasound in 3 patients and during exploratory surgical intervention in the other. All tears were repaired primarily without the aid of cardiopulmonary bypass.

Results. Three of the patients survived, and 1 died.

Conclusions. Rarely are patients with rupture of the free cardiac wall seen in an emergency department. The improvements in the prehospital care and the transportation may result in an increase in the numbers of such patients. Physicians treating patients with blunt trauma must suspect the presence of cardiac rupture. Immediate use of ultrasonography will establish the diagnosis and prompt repair of the injury may improve overall survival.

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