Effect of alcohol upon arrhythmias following nonpenetrating cardiac impact

The purpose of this study was to determine if alcohol worsens arrhythmias produced by nonpenetrating cardiac impact. Twenty-three dogs were studied. Twelve underwent nonpenetrating cardiac impact alone at 12 m/sec with a contact compression of 2 cm. Eleven underwent cardiac impact after having received intravenous alcohol (blood level of 197 +/- 37 mg/100 ml) (mean +/- SD). Three dogs experienced ventricular fibrillation immediately after impact and died: of these, two underwent impact alone and one underwent impact following ethanol. These three dogs were eliminated from the study. All of the dogs had some form of complex arrhythmia during the first 10 minutes of observation, the average cumulative duration of which during the first 10 minutes following trauma was greater among dogs that received ethanol. No complex arrhythmias other than ventricular premature contractions or ventricular tachycardia were observed after the first 10 minutes following impact. During the first 2 hours of observation following cardiac impact, dogs that received alcohol before trauma showed more single premature ventricular contractions (p less than 0.03), couplets (p less than 0.01), triplets (p less than 0.02), runs of 4-20 beats (p less than 0.05), and total number of premature ventricular contractions (p less than 0.05) than dogs that underwent trauma alone. Following the first 10 minutes, ventricular irritability increased with time until approximately 1 hour, and then there was a gradual reduction of the frequency of arrhythmias in both dogs that received alcohol and those that did not. In conclusion, nonpenetrating cardiac impact in dogs that previously received ethanol was associated with greater ventricular irritability than in dogs that underwent impact alone.     

Survival after blunt traumatic rupture of the left ventricle

There have been 11 reported survivors from blunt-trauma-induced right ventricular rupture and only three from left ventricular rupture. We report the fourth case of a survivor of blunt left ventricular rupture. This patient presented with hypotension from both hemorrhage into the left chest and pericardial tamponade. The tamponade was relieved via an emergent left thoracotomy, the bleeding from the rent in the left ventricle was easily controlled, and repair was straightforward.     

Splenic regeneration following splenectomy for traumatic rupture

Thirty-three patients previously splenectomized following traumatic rupture of the spleen were assessed using a radionuclide technique. Splenic tissue was detected by this means in 22 patients (67%). Peripheral venous blood was examined for the presence of erythrocyte surface vacuoles. Vacuolated red blood cells were detected more frequently than in the normal population. The incidence of vacuolated red blood cells was inversely related to the estimated volume of regenerated splenic tissue.     

Longitudinal evaluation of left ventricular performance in dogs following nonpenetrating cardiac trauma

To investigate the temporal changes of global left ventricular function following nonpenetrating cardiac impact, studies were performed in ten purpose-bred dogs. Under full anesthesia and after hemodynamic and angiographic measurement, a midline thoracotomy was performed and a 12 m/sec blunt impact was delivered to the anterior surface of the heart in eight dogs with an air-pressurized impactor. Two dogs were sham operated and did not undergo trauma. After closing the chest, the hemodynamic measurements were repeated at 3 hours, 3 days, 2 weeks, and 5 weeks after impact. Hemodynamic measurements included left ventricular end-diastolic pressure and peak left ventricular positive and negative rates of change of pressure. Left ventricular ejection fraction was calculated from ventriculograms obtained with the dog positioned on its right side. All indices of left ventricular performance in dogs that underwent trauma were depressed at 3 hours after impact and recovered gradually to near normal levels at 2 to 5 weeks after trauma. Recovery of left ventricular function occurred in spite of residual patchy scarring of the left ventricular myocardium in the region of impact. No variability of left ventricular function indices was observed over the course of the study in the two sham-operated dogs. The results indicate that blunt cardiac impact can cause depression of left ventricular performance in the immediate post-impact period, but near complete recovery of function occurs within 2 to 5 weeks after the injury, in spite of residual scarring.     

Blunt traumatic cardiac rupture: Therapeutic options and outcomes

Introduction

Cardiac rupture following blunt thoracic trauma is rarely encountered by clinicians, since it commonly causes death at the scene. With advances in traumatology, blunt cardiac rupture had been increasingly disclosed in various ways. This study reviews our experience of patients with suspected blunt traumatic cardiac rupture and proposes treatment protocols for the same.

Methods

This is a 5-year retrospective study of trauma patients confirmed with blunt traumatic cardiac rupture admitted to a university-affiliated tertiary trauma referral centre. The following information was collected from the patients: age, sex, mechanism of injury, initial effective diagnostic tool used for diagnosing blunt cardiac rupture, location and size of the cardiac injury, associated injury and injury severity score (ISS), reversed trauma score (RTS), survival probability of trauma and injury severity scoring (TRISS), vital signs and biochemical lab data on arrival at the trauma centre, time elapsed from injury to diagnosis and surgery, surgical details, hospital course and final outcome.

Results

The study comprised 8 men and 3 women with a median age of 39 years (range: 24-73 years) and the median follow-up was 5.5 months (range: 1-35 months). The ISS, RTS, and TRISS scores of the patients were 32.18 ± 5.7 (range: 25-43), 6.267 ± 1.684 (range: 2.628-7.841), and 72.4 ± 25.6% (range: 28.6-95.5%), respectively. Cardiac injuries were first detected using focused assessment with sonography for trauma (FAST) in 4 (36.3%) patients, using transthoracic echocardiography in 3 (27.3%) patients, chest CT in 1 (9%) patient, and intra-operatively in 3 (27.3%) patients. The sites of cardiac injury comprised the superior vena cava/right atrium junction (n = 4), right atrial auricle (n = 1), right ventricle (n = 4), left ventricular contusion (n = 1), and diffuse endomyocardial dissection over the right and left ventricles (n = 1). Notably, 2 had pericardial lacerations presenting as a massive haemothorax, which initially masked the cardiac rupture. The in-hospital mortality was 27.3% (3/11) with 1 intra-operative death, 1 multiple organ failure, and 1 death while waiting for cardiac transplantation. Another patient with morbid neurological defects died on the thirty-third postoperative day; the overall survival was 63.6% (7/11). Compared with the surviving patients, the fatalities had higher RTS and TRISS scores, serum creatinine levels, had received greater blood transfusions, and had a worse preoperative conscious state.

Conclusions

We proposed a protocol combining various diagnostic tools, including FAST, CT, transthoracic echocardiography, and TEE, to manage suspected blunt traumatic cardiac rupture. Pericardial defects can mask the cardiac lesion and complicate definite cardiac repair. Comorbid trauma, particularly neurological injury, may have an impact on the survival of such patients, despite timely repair of the cardiac lesions.     

15例外伤性心脏破裂的救治体会

目的 探讨外伤性心脏破裂的救治方法,以提高抢救成功率.方法 对我院心胸外科于2000年12月～2010年12月收治的15例外伤性心脏破裂进行回顾性分析.多数患者经心脏彩超确诊,15例患者均及时施行开胸手术修补.结果 本组治愈14例,治愈率93％,死亡1例,占7％.本组无严重并发症.结论 快速而准确的诊断是外伤性心脏破裂...     

Blunt traumatic cardiac rupture. A 5-year experience.

Blunt traumatic cardiac rupture is associated with a high rate of mortality. A review of the computerized trauma registry (1983 to 1988) identified 32 patients with this injury (ages 19 to 65 years; mean age, 39.5 years; 21 men and 11 women). Twenty-one patients (65.6%) were injured in vehicular crashes, 3 (9.4%) in pedestrian accidents, 3 (9.4%) in motorcycle accidents; 3 (9.4%) sustained crush injury; 1 (3.1%) was injured by a fall; and 1 (3.1%) was kicked in the chest by a horse. Anatomic injuries included right atrial rupture (13[40.6%]), left atrial rupture (8 [25%]), right ventricular rupture (10[31.3%]), left ventricular rupture (4[12.5%]), and rupture of two cardiac chambers (3 [9.4%]). Diagnosis was made by thoracotomy in all 20 patients presenting in cardiac arrest. In the remaining 12 patients, the diagnosis was established in seven by emergency left anterolateral thoracotomy and in five by subxyphoid pericardial window. Seven of these 12 patients (58.3%) had clinical cardiac tamponade and significant upper torso cyanosis. The mean Injury Severity Score (ISS), Trauma Score (TS), and Glasgow Coma Scale (GCS) score were 33.8, 13.2, and 14.3, respectively, among survivors and 51.5, 8.3, and 7.0 for nonsurvivors. The overall mortality rate was 81.3% (26 of 32 patients), the only survivors being those presenting with vital signs (6 of 12 patients [50%]). All patients with rupture of two cardiac chambers or with ventricular rupture died. The mortality rate from myocardial rupture is very high. Rapid prehospital transportation, a high index of suspicion, and prompt surgical intervention contribute to survival in these patients.     

Subacute tricuspid valve rupture after traumatic cardiac and pulmonary contusions

Tricuspid valve rupture is a rare complication after blunt chest trauma. We report the unusual presentation of a patient that suffered traumatic cardiac and pulmonary contusions, contributing to the rupture of the posterior papillary muscle of the tricuspid valve 24 hours after presentation. We believe that this is the first reported case of subacute tricuspid valve rupture after a normal echocardiogram at admission after blunt chest trauma.