Left atrial appendage tear due to blunt trauma to the chest

This case report presents the successful surgical management of a 34-year-old male who had blunt chest trauma resulting in a left atrial appendage tear after a traffic accident. He arrived at the emergency department 30 minutes post-injury in a gasping state, showing signs of hypovolemic shock, tachycardia (132 bpm), hypotension (blood pressure 88/48 mm Hg) and decreased breath sounds on the left side. The initial management included fluid resuscitation and the insertion of an intercostal drain, which drained 1.2 litres of blood. After the initial fluid resuscitation, haemodynamic stability was achieved with no further drainage from the chest tube. A computed tomography scan revealed haemothorax, bilateral rib fractures, right clavicular and scapular fractures and no active contrast extravasation. However, in the intensive care unit, the chest tube drainage suddenly increased to 250-300 ml/hour with escalating vasopressor requirements. An emergency left chest exploration was performed using thoracoscopy, which revealed significant blood clots and active bleeding from a pericardial defect, leading to conversion to an antero-lateral thoracotomy. The left atrial appendage tear was identified and repaired, achieving complete haemostasis. Postoperatively, the patient stabilized with ongoing intensive care management. This case underscores the challenges in managing traumatic cardiac injuries and highlights the critical need for timely surgical intervention to enhance survival outcomes in severely injured patients.