Telich-Tarriba Jose E, Anaya-Ayala Javier E, Reardon Michael J
Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas 77030, USA.
Tex Heart Inst J. 2012;39(4):579-81.
Right atrial wall rupture after blunt chest trauma is a catastrophic event associated with high mortality rates. We report the case of a 24-year-old woman who was ejected 40 feet during a motor vehicle accident. Upon presentation, she was awake and alert, with a systolic blood pressure of 100 mmHg. Chest computed tomography disclosed a large pericardial effusion; transthoracic echocardiography confirmed this finding and also found right ventricular diastolic collapse. A diagnosis of cardiac tamponade with probable cardiac injury was made; the patient was taken to the operating room, where median sternotomy revealed a 1-cm laceration of the right atrial appendage. This lesion was directly repaired with 4-0 polypropylene suture. Her postoperative course was uneventful, and she continued to recover from injuries to the musculoskeletal system. This case highlights the need for a high degree of suspicion of cardiac injuries after blunt chest trauma. An algorithm is proposed for rapid recognition, diagnosis, and treatment of these lesions.
钝性胸部创伤后右心房壁破裂是一种灾难性事件，死亡率很高。我们报告一例24岁女性，在机动车事故中被抛出40英尺。就诊时，她清醒且警觉，收缩压为100 mmHg。胸部计算机断层扫描显示大量心包积液；经胸超声心动图证实了这一发现，并发现右心室舒张期塌陷。诊断为心脏压塞伴可能的心脏损伤；患者被送往手术室，正中胸骨切开术显示右心耳有一处1厘米的裂伤。用4-0聚丙烯缝线直接修复该病变。她的术后过程顺利，继续从肌肉骨骼系统损伤中恢复。该病例强调了钝性胸部创伤后对心脏损伤高度怀疑的必要性。提出了一种用于快速识别、诊断和治疗这些病变的算法。
