Zhu Huangkai, Zhang Chenxu, Zhao Weidi, Xu Xiang, Shi Yiting, Zhao Guofang
Department of Cardiothoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), Ningbo, China.
Medical School of Ningbo University, Ningbo, China.
Ann Transl Med. 2021 Jun;9(12):1028. doi: 10.21037/atm-21-3031.
Blunt cardiac rupture (BCR) is a rare injury with a high mortality rate. It is usually caused by high-energy traumatic accidents, such as motor vehicle collisions. For the first time, we report a rare case of BCR caused by a pedestrian collision with a stationary motor vehicle, which is a low-energy traumatic accident. This is also the first surgical survival BCR case to be reported of a contralateral ventricular rupture at the direct stress site. A 45-year-old formerly healthy Chinese woman, with no family history of heart disease, was walking in a hurry when she accidentally hit a forklift that was parked on the side of the road. The patient gradually lost consciousness, and was admitted to Hwa Mei Hospital Emergency Center 1 hour later. An ultrasound revealed a pericardial effusion about 1 cm deep and a small amount of peritoneal -35 effusion. Emergency computed tomography (CT) scans revealed a small amount of fluid accumulation in the right thoracic cavity, fractures of the 5th and 6th ribs on the right side, and pericardial effusion. The patient's blood pressure remained unstable after 1 hour of endotracheal intubation, B-ultrasound-guided pericardiocentesis, and antishock therapy; thus, open-heart surgery was deemed necessary. A large amount of blood accumulation was found in the intact pericardium. There was a small blood clot at the apex of the left ventricle near the interventricular septum. The removal of the clot revealed a tear about 1 cm in diameter. The patient's BCR was successfully repaired in the surgery. By the end of the 18-month follow-up period, the patient was found to have recovered well without significant complications. The internal mechanism of the case report was deceleration. Prompt diagnosis and emergency thoracotomy when BCR is suspected are key to rescuing patients, regardless of whether the accident is high energy or low energy, or if there is evidence of a direct force acting on the precordium, or the presence of pericardial rupture.
钝性心脏破裂（BCR）是一种罕见但死亡率很高的损伤。它通常由高能创伤事故引起，如机动车碰撞。我们首次报告了一例罕见的因行人与静止机动车碰撞导致的BCR，这是一起低能创伤事故。这也是首例报道的在直接应力部位对侧心室破裂且手术成功存活的BCR病例。一名45岁既往健康、无心脏病家族史的中国女性，在匆忙行走时不慎撞到停在路边的一辆叉车。患者逐渐失去意识，1小时后被送入华美医院急救中心。超声检查显示心包积液约1厘米深，少量腹腔积液。急诊计算机断层扫描（CT）显示右侧胸腔少量积液、右侧第5和第6肋骨骨折以及心包积液。在进行气管插管、B超引导下心包穿刺和抗休克治疗1小时后，患者血压仍不稳定；因此，认为有必要进行心脏直视手术。在完整的心包内发现大量积血。在靠近室间隔的左心室心尖处有一个小血块。清除血块后发现一个直径约1厘米的撕裂口。患者的BCR在手术中成功修复。在18个月的随访期结束时，发现患者恢复良好，无明显并发症。该病例报告的内在机制是减速。无论事故是高能还是低能，或者是否有直接作用于胸前区的力的证据，或者是否存在心包破裂，当怀疑BCR时迅速诊断并紧急开胸是抢救患者的关键。
