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Blunt cardiac rupture in the setting of previous sternotomy

Stephanie Ch'ng1, Brian Plunkett, Ashutosh Hardikar

  • 1Department of Cardiothoracic Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia. zlt.chng@gmail.com

The Annals of Thoracic Surgery
|May 15, 2012
PubMed

Insights

Blunt cardiac rupture (BCR) is often fatal, but previous sternotomy may offer protection. A patient with right ventricular tears after prior bypass surgery survived and was treated conservatively.

Area of Science:

  • Cardiovascular Surgery
  • Trauma Surgery
  • Emergency Medicine

Background:

  • Blunt cardiac rupture (BCR) typically has a high mortality rate, with surgical repair being the standard treatment for survivors.
  • Previous sternotomy can lead to pericardial adhesions, potentially altering the injury pattern and outcome in cases of blunt chest trauma.

Observation:

  • A patient with a history of coronary artery bypass graft surgery sustained two right ventricular tears due to blunt trauma from a motor vehicle accident.
  • Despite the significant cardiac injury, the patient did not exhibit hemodynamic compromise, possibly due to protective pericardial adhesions from the prior sternotomy.

Findings:

  • The patient's presentation suggested that pre-existing pericardial adhesions may mitigate the severity of cardiac tamponade following blunt cardiac rupture.
  • Conservative management was successful in this unique case, deviating from the typical surgical intervention for BCR.

Implications:

  • This case highlights the potential protective role of pericardial adhesions in blunt cardiac rupture after sternotomy.
  • It suggests that conservative management might be a viable option for select patients with BCR and prior sternotomy, warranting further investigation.

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