Survival after severe blunt cardiac injury: Right atrial rupture.

Background: Blunt cardiac rupture is a rare but life-threatening injury that imparts extremely high mortality. Most patients who experience cardiac rupture die at the scene, but timely response in diagnosis and treatment can improve the survivability of this injury. Purpose: To describe a case of blunt cardiac injury with right atrial rupture after involvement in a high-speed motor vehicle collision. Early resuscitation with blood products and timely operative treatment were pivotal for the survival of this patient. Follow up with echocardiography revealed a rare presentation of inter-atrial septal aneurysm formation. Case presentation: A 37 year old man presented by ambulance after involvement in a high-speed motor vehicle collision. On arrival, he was agitated but hemodynamically stable. Chest x-ray showed a massive right-sided pleural effusion and placement of right sided chest tube immediately drained more than 1300 mL of dark blood. Massive blood product transfusion was initiated and the patient was taken to the operating room for emergent right anterior thoracotomy. A laceration to the pericardium was identified and right atrial rupture which were managed by primary repair and wide drainage. Echocardiography in the post-traumatic period demonstrated an inter-atrial septal aneurysm that was managed conservatively. Conclusion: Survival after blunt cardiac rupture is rare but feasible if aggressive blood product resuscitation and timely operative treatment are provided. Close follow up with serial echocardiography in the peri-traumatic and post-traumatic period is imperative to assess for associated cardiac complications.