Diagnosis and treatment of blunt cardiac rupture

Blunt cardiac rupture is rare, but when it does occur it is almost immediately fatal. In patients surviving the initial insult, the overall mortality rate is 60%-90%. Patients typically present with either cardiac tamponade or massive hemothorax. We report a case of blunt cardiac rupture in a young male who had prolonged transfer time with survival. He presented with an intact pericardium and cardiac tamponade. In stable patients, the diagnosis can be confirmed with emergent echocardiography prior to operative intervention. If unstable, then subxiphoid pericardial window is both diagnostic and therapeutic. The repair is approached via either a left anterior thoracotomy or median sternotomy. The incision is usually dictated by the physiologic status of the patient at presentation. We conclude that patients with blunt cardiac rupture can be saved, especially those with vital signs are still strong when treatment is begun. Early diagnosis is the key to survival for patient with this rare condition.