Subject(s)
Atrial Appendage , Heart Injuries , Wounds, Nonpenetrating , Humans , Atrial Appendage/diagnostic imaging , Atrial Appendage/surgery , Atrial Appendage/injuries , Heart Injuries/diagnostic imaging , Heart Injuries/etiology , Heart Injuries/surgery , Wounds, Nonpenetrating/diagnostic imagingABSTRACT
A 20-year-old woman presented to our trauma center with cardiac rupture after a motor vehicle collision. Our patient was the restrained driver in a high-speed collision. She arrived without external evidence of trauma but in obvious distress with tachycardia, tachypnea, and hypotension. Initial FAST was negative and chest x-ray; however, second FAST was equivocal for pericardial fluid. Computed tomography demonstrated a large hemopericardium, suspicious for cardiac injury. She underwent emergent operative exploration with a median sternotomy. A 1 cm right atrial appendage avulsion was identified and repaired primarily. She recovered uneventfully and was discharged home. Survival of blunt cardiac rupture is extremely rare and can occur in the absence of any external signs of trauma. Surgeons should maintain clinical suspicion for blunt cardiac injury in unstable trauma patients with deceleration injuries. Injury to the low-pressure right atrium likely contributed to her ability to survive transport to a trauma center.
Subject(s)
Atrial Appendage , Heart Injuries , Heart Rupture , Pericardial Effusion , Thoracic Injuries , Wounds, Nonpenetrating , Adult , Atrial Appendage/diagnostic imaging , Atrial Appendage/injuries , Atrial Appendage/surgery , Female , Heart Injuries/diagnosis , Heart Injuries/etiology , Heart Injuries/surgery , Heart Rupture/surgery , Humans , Rupture , Survivors , Thoracic Injuries/complications , Thoracic Injuries/surgery , Wounds, Nonpenetrating/surgery , Young AdultABSTRACT
ABSTRACT: Isolated right atrial rupture after nonpenetrating blunt chest trauma is rare, and very few cases have been reported in the literature. Isolated right atrial rupture is a diagnostic challenge in these patients, who are mostly victims of motor vehicle collisions. The clinical presentation is heterogeneous and can vary depending on rupture location and size. The anatomical sites mostly involved are the appendage and the free wall followed by the superior and inferior vena cava junctions. The present case study shows a fatal isolated rupture of the right atrial appendage in a victim of a motor vehicle collision. At the emergency room, a computed tomography scan revealed a severe pericardial blood effusion, and pericardiocentesis was promptly performed. Unfortunately, the patient suddenly worsened just before cardiac surgery. Autopsy findings showed a cardiac tamponade due to a linear laceration 1.8 cm in length on the right atrial appendage. No other relevant injuries were observed. A prompt diagnosis of isolated right atrial rupture can be crucial for victims of blunt chest trauma with unexplained hypotension or hemodynamic instability to improve their chances of survival. Medicolegal issues can be raised mainly related to delayed diagnosis. Once a cardiac rupture is suspected, the injury repair is essential to achieve the best outcome.
Subject(s)
Accidents, Traffic , Atrial Appendage/injuries , Atrial Appendage/pathology , Rupture/pathology , Wounds, Nonpenetrating/complications , Cardiac Tamponade/etiology , Fatal Outcome , Humans , Male , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/etiology , Rupture/etiology , Tomography, X-Ray Computed , Young AdultSubject(s)
Atrial Appendage/injuries , Cardiac Catheterization/adverse effects , Intraoperative Complications/therapy , Pericardial Effusion/therapy , Resuscitation/methods , Aged , Atrial Appendage/diagnostic imaging , Atrial Appendage/surgery , Atrial Fibrillation/complications , Atrial Fibrillation/surgery , Blood Transfusion, Autologous , Cardiac Catheterization/instrumentation , Coronary Artery Disease/complications , Coronary Artery Disease/surgery , Echocardiography, Transesophageal , Heart Failure/complications , Heart Failure/surgery , Humans , Hypertension/complications , Hypertension/surgery , Intraoperative Complications/diagnosis , Intraoperative Complications/etiology , Male , Pericardial Effusion/diagnosis , Pericardial Effusion/etiology , Pericardiocentesis , Treatment OutcomeABSTRACT
BACKGROUND: Isolated right atrial rupture (IRAR) from blunt chest trauma is rare. There are no physical exam findings and non-invasive testing specific to the condition, which result in diagnostic delays and poor outcomes. We present a case of IRAR along with a systematic review of similar cases in the literature. CASE REPORT: A 23-year-old male presented following a motor vehicle accident (MVA). He was bradycardic and hypotensive during transportation; and required intubation. There were contusions along the right chest wall with clear breath sounds, and no jugular venous distension, muffled heart sounds. Hemodynamic status progressively worsened, ultimately leading to his death. However, no external sources of bleeding or evidence of cardiac tamponade was found. METHODS: A search of PubMed, Ovid, and the Cochrane Library using: (Blunt OR Blunt trauma) AND (Laceration OR Rupture OR Tear) AND (Right Atrium OR Right Atrial). Articles were included if they were original articles describing cases of IRAR. RESULTS: Forty-five reports comprising seventy-five (n = 75) cases of IRAR. CONCLUSION: IRAR most commonly occurs following MVAs as the result of blunt chest trauma. Rupture occurs at four distinct sites and is most commonly at the right atrial appendage. IRAR is a diagnostic challenge and requires a high index of suspicion, as patients' hemodynamics can rapidly deteriorate. The presentations vary depending on multiple factors including rupture size, pericardial integrity, and concomitant injuries. Cardiac tamponade may have a protective effect by prompting the search for a bleeding source. A pericardial window can be diagnostic and therapeutic in IRAR. Outcomes are favourable with timely recognition and prompt surgical intervention.
Subject(s)
Atrial Appendage/injuries , Heart Injuries/diagnosis , Wounds, Nonpenetrating/complications , Accidents, Traffic , Fatal Outcome , Heart Injuries/etiology , Heart Injuries/physiopathology , Hemodynamics , Humans , Male , Young AdultABSTRACT
The left atrial appendage (LAA) is a major site of clot formation in atrial fibrillation. Stand-alone thoracoscopic LAA complete closure can decrease stroke risk and may be an alternative to life-long oral anticoagulation. This report describes a technique for totally thoracoscopic LAA exclusion with an epicardial clip device. This approach provides a safe and likely more effective alternative to LAA management than other endocardial devices.
Subject(s)
Atrial Appendage/surgery , Thoracoscopy/methods , Atrial Appendage/diagnostic imaging , Atrial Appendage/injuries , Atrial Fibrillation/complications , Computed Tomography Angiography , Humans , Intraoperative Complications/surgery , Pericardiectomy/methods , Thromboembolism/etiology , Thromboembolism/prevention & controlABSTRACT
Left atrial appendage (LAA) perforation is a possible complication not only after release of the closure device, but also during the diagnostic phase due to sheath positioning in the LAA. We present an 83-year-old woman with permanent atrial fibrillation and high thromboembolic and bleeding risk who was admitted for elective percutaneous LAA closure. During angiographic study, she suddenly became hypotensive. Heart perforation with leakage of contrast in the pericardial space was evident and imaging confirmed cardiac tamponade. Rapid release of the closure device and pericardial evacuation allowed the operators to successfully manage the cardiac tamponade and avoid a surgical option.
Subject(s)
Atrial Appendage/injuries , Atrial Fibrillation/surgery , Cardiac Catheterization/adverse effects , Cardiac Tamponade/etiology , Heart Injuries/etiology , Septal Occluder Device/adverse effects , Aged, 80 and over , Angiography , Atrial Appendage/diagnostic imaging , Atrial Fibrillation/diagnosis , Blood Transfusion, Autologous/methods , Cardiac Tamponade/diagnosis , Cardiac Tamponade/therapy , Echocardiography, Transesophageal , Female , Heart Injuries/complications , Heart Injuries/diagnosis , Heart Injuries/therapy , Humans , Pericardiocentesis , Time FactorsSubject(s)
Atrial Appendage/injuries , Atrial Fibrillation/therapy , Cardiac Catheterization/adverse effects , Heart Injuries/etiology , Pericardial Effusion/prevention & control , Pulmonary Veins/injuries , Aged, 80 and over , Atrial Appendage/diagnostic imaging , Atrial Fibrillation/diagnostic imaging , Cardiac Catheterization/instrumentation , Heart Injuries/diagnostic imaging , Humans , Male , Pericardial Effusion/etiology , Pulmonary Veins/diagnostic imaging , Treatment OutcomeABSTRACT
Background Percutaneous device closure of an ostium secundum atrial septal defect is associated with excellent outcomes and cosmetic results but at the cost of occasional serious and sometimes fatal complications as well as lifelong follow-up. Surgical intervention is required in cases of device-related complications, which carries a slightly higher risk compared to primary closure of an atrial septal defect. We present a surgical perspective of device closure of atrial septal defect. Methods Our database was searched over 4 years for complications related to percutaneous device closure of atrial septal defect, which required surgical retrieval of the device and closure of the defect. We identified 14 cases that required surgical intervention. Results The median age of the 14 patients was 18 years (range 4-58 years). The size of the defect ranged from 15 to 40 mm (median 30 mm). Device embolization into any part of the cardiovascular system ( n = 8) was the most common complication, followed by malalignment of the device ( n = 5). One patient had left atrial appendage perforation causing pericardial effusion and cardiac tamponade, and underwent surgical repair. The other 13 patients underwent removal of the device and atrial septal defect closure. One patient developed severe mitral regurgitation requiring mitral valve replacement. There was no mortality. Conclusion Although the incidence of device-related complications may be small, they carry a high risk of death or long-term morbidity, even with a small atrial septal defect, unlike primary surgical closure of isolated atrial septal defect.
Subject(s)
Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Device Removal/methods , Foreign-Body Migration/surgery , Heart Septal Defects, Atrial/therapy , Mitral Valve Insufficiency/surgery , Septal Occluder Device/adverse effects , Adolescent , Adult , Atrial Appendage/injuries , Atrial Appendage/surgery , Cardiac Tamponade/etiology , Cardiac Tamponade/surgery , Child , Child, Preschool , Databases, Factual , Device Removal/adverse effects , Female , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/etiology , Heart Injuries/etiology , Heart Injuries/surgery , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Mitral Valve Insufficiency/etiology , Pericardial Effusion/etiology , Pericardial Effusion/surgery , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Young AdultSubject(s)
Atrial Appendage/injuries , Atrial Fibrillation/therapy , Cardiac Catheterization/adverse effects , Heart Injuries/therapy , Pericardial Effusion/therapy , Aged , Atrial Appendage/diagnostic imaging , Atrial Fibrillation/diagnosis , Echocardiography, Transesophageal , Female , Heart Injuries/diagnostic imaging , Heart Injuries/etiology , Humans , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/etiology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A 42-year-old man sustained blunt thoracic trauma after a motor vehicle accident. He underwent an urgent operation. Operative findings included a large hematoma, a 4-cm tear in the left atrial appendage, and a long pleuropericardial rupture along the right phrenic nerve. We repaired the left atrial appendage without cardiopulmonary bypass, and closed the pericardial defect primarily. The patient recovered fully and was discharged on the 6th postoperative day.
Subject(s)
Atrial Appendage/injuries , Heart Injuries/etiology , Hernia/etiology , Wounds, Nonpenetrating/etiology , Accidents, Traffic , Adult , Atrial Appendage/diagnostic imaging , Atrial Appendage/surgery , Cardiac Surgical Procedures , Cardiopulmonary Bypass , Heart Injuries/diagnostic imaging , Heart Injuries/surgery , Hernia/diagnostic imaging , Herniorrhaphy , Humans , Male , Suture Techniques , Tomography, X-Ray Computed , Treatment Outcome , Wounds, Nonpenetrating/diagnostic imaging , Wounds, Nonpenetrating/surgeryABSTRACT
Lead perforation is a rare complication of device implantation, varying between 0.3% and 1%, although the prevalence may be higher. Late lead perforations (>1 month after implantation) are believed to be very rare. We describe the successful treatment of a 65-year-old man with late cardiac perforation due to the pacemaker active fixation lead after an uneventful implantation.
Subject(s)
Atrial Appendage/injuries , Atrioventricular Block/therapy , Cardiac Pacing, Artificial/adverse effects , Heart Injuries/etiology , Pacemaker, Artificial/adverse effects , Aged , Atrial Appendage/diagnostic imaging , Atrial Appendage/surgery , Atrioventricular Block/diagnosis , Cardiac Surgical Procedures , Cardiac Tamponade/etiology , Drainage , Echocardiography, Doppler , Equipment Design , Heart Injuries/diagnosis , Heart Injuries/surgery , Humans , Male , Pericardial Effusion/etiology , Radiography , Reoperation , Sternotomy , Suture Techniques , Treatment OutcomeABSTRACT
A 76-year-old male patient was admitted for percutaneous left atrial appendage (LAA) closure because of chronic atrial fibrillation and a history of gastrointestinal bleeding under oral anticoagulation. The procedure was complicated by perforation of the LAA with the lobe of the closure device being placed in the pericardial space. Keeping access to the pericardial space with the delivery sheath, the LAA closure device was replaced by an atrial septal defect closure device to seal the perforation. Then the initial LAA closure device was reimplanted in a correct position. Needle pericardiocentesis was required but the subsequent course was uneventful.
Subject(s)
Atrial Fibrillation/therapy , Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Cardiac Catheters , Heart Injuries/therapy , Septal Occluder Device , Atrial Appendage/injuries , Atrial Fibrillation/diagnosis , Equipment Design , Heart Injuries/diagnosis , Heart Injuries/etiology , Humans , Male , Pericardiocentesis , Radiography, Interventional , Treatment OutcomeABSTRACT
We report an 88-year-old male with coronary artery disease, previously placed left main coronary artery drug-eluting stent, and atrial fibrillation unable to tolerate anticoagulation with warfarin in addition to dual antiplatelet therapy who underwent percutaneous catheter-based ligation of the left atrial appendage. During the procedure, left atrial appendage perforation occurred with resultant pericardial effusion. The novel LARIAT suture delivery system (SentreHEART) allowed immediate and definitive management of this complication and effective ligation of the left atrial appendage. Prospective studies are needed to determine whether this is a safe and effective method for thromboembolism prophylaxis in patients with atrial fibrillation, but its novel design incorporates an immediate resolution to the most-feared complication of catheter-based left atrial appendage manipulation while effectively excluding the left atrial appendage via suture ligation.
Subject(s)
Atrial Appendage/injuries , Atrial Appendage/surgery , Cardiac Catheters , Percutaneous Coronary Intervention/methods , Suture Techniques , Sutures , Aged, 80 and over , Anticoagulants/therapeutic use , Cardiac Catheterization/instrumentation , Cardiac Catheterization/methods , Cardiac Surgical Procedures/methods , Drug-Eluting Stents , Humans , Ligation , Male , Percutaneous Coronary Intervention/instrumentation , Thromboembolism/prevention & control , Treatment OutcomeABSTRACT
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.
Subject(s)
Accidents, Traffic , Cardiac Surgical Procedures , Heart Injuries/surgery , Wounds, Nonpenetrating/surgery , Algorithms , Atrial Appendage/injuries , Atrial Appendage/surgery , Cardiac Tamponade/etiology , Cardiac Tamponade/surgery , Echocardiography , Female , Heart Injuries/diagnosis , Heart Injuries/etiology , Heart Injuries/physiopathology , Hemodynamics , Humans , Pericardial Effusion/etiology , Pericardial Effusion/surgery , Sternotomy , Suture Techniques , Tomography, X-Ray Computed , Treatment Outcome , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/etiology , Wounds, Nonpenetrating/physiopathology , Young AdultABSTRACT
A 66-year-old man was implanted with a pacemaker. Seven years after implantation he was admitted due to cardiogenic cerebral embolism and warfarin therapy was introduced. After that, he suffered recurrent pericardial effusion for unexplained reasons. An exploratory thoracotomy revealed that the screw of the atrial lead had penetrated through the right auricular appendage wall.