Blunt rupture of the myocardium.

With the evolution of regional trauma systems, patients with severe cardiac injury are arriving in emergency departments with the potential for survival. This paper reviews the 61 survivors of nonpenetrating rupture of the free walls of the myocardium reported in the English-language literature. The chambers were involved in the following frequency: right atrium, 36; left atrium, 11; right ventricle, 12; and left ventricle, four. Most victims were young males, and 85% were involved in motor vehicle accidents. Seventy percent had an admission systolic blood pressure less than 80 mm Hg, 78% had distended neck veins or a central venous pressure greater than 20 cm H2O, 67% had a widened mediastinum on admission chest roentgenogram, and 48% had fractures of the bony thorax. More than one hour elapsed before initiation of repair in 59%. Forty-eight percent of the repairs were performed via a median sternotomy. Cardiopulmonary bypass was used in only 10%.