title: Surgical repair of right atrial wall rupture after blunt chest trauma.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas 77030, USA.
authors.forename: Jose E
authors.initials: JE
authors.lastname: Telich-Tarriba
authors.forename: Javier E
authors.initials: JE
authors.lastname: Anaya-Ayala
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Reardon
mesh_terms: D000063:Accidents, Traffic; D000465:Algorithms; D020517:Atrial Appendage / Q000293:injuries / Q000601:surgery; D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D010490:Pericardial Effusion / Q000209:etiology / Q000601:surgery; D056346:Sternotomy; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult