Skip to main content
Download PDF
Download ePub

Isolated right atrial rupture from blunt trauma: a case report with systematic review of a lethal injury

Journal of Cardiothoracic Surgery volume 14, Article number: 28 (2019) Cite this article

Abstract

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.

Peer Review reports

Introduction

Isolated right atrial rupture (IRAR) is a rare injury that occurs secondary to blunt chest trauma. Blunt cardiac rupture (BCR) of the right atrium (RA) has a reported incidence between 0.2–0.5% and occurs concomitantly with BCR of another cardiac chamber [1,2,3]. Only 10% of patients survive long enough to make it to a hospital [3]. IRAR has heterogeneous clinical manifestations and non-specific laboratory test findings which can delay time for life-saving interventions [4,5,6].

Due to the paucity in available literature, our knowledge of the condition is limited however cases of IRAR are more commonly encountered than previously thought. Herein, we present a case of IRAR following blunt chest trauma. We also conducted a systematic review of previously reported cases with the primary objective of highlighting unique features of the condition, including its etiology, anatomy, presentations, and outcomes; as well as previously reported practices in diagnosis and management.

Case report

A 23-year-old man was flown in to our level I trauma center following an MVA collision about 2–3 h prior. En route, he became bradycardic and required intubation after losing consciousness. On presentation to our hospital, his vitals were as follows: heart rate 116-bpm; blood pressure 252/183-mmHg; respiratory rate of 19; and SpO2 of 98% on mechanical ventilation.

On examination, the patient was unconscious with dilated and unreactive eyes/pupils. He had several superficial abrasions and an open left femur fracture. There was a 9 × 7 cm contusion along the right chest wall, but chest was clear to auscultation without muffled heart sounds. Carotid, femoral and distal extremity pulses were all 1+ bilaterally without jugular venous distension. He also had mild abdominal distension, left flank ecchymosis, and absent rectal sphincter tone.

Focused assessment with sonography for trauma (FAST) only showed scant abdominal fluid and was negative for tamponade. Bilateral chest tubes were inserted due to suspicion of hemothorax, but produced minimal drainage. The patient deteriorated rapidly despite further resuscitative efforts, which were eventually discontinued at time of death.

Subsequent autopsy revealed an isolated tear in the right cardiac atrium at the junction of the inferior vena cava (IVC). Other findings included bilateral pulmonary contusions, blood in the pleural and peritoneal cavities, and small lacerations of the spleen and liver.

Methods

A search of all original studies was conducted using PubMed, Ovid, and the Cochrane Library. The following search was performed in PubMed in December 2016: (Blunt OR Blunt trauma) AND (Laceration OR Rupture OR Tear) AND (Right Atrium OR Right Atrial). Publications were limited to publish date after 1955. Language was limited to English. Search was limited to full text. The search was repeated in Ovid and Cochrane library. Abstracts were reviewed, and those that met the selection criteria specified later were imported into a Microsoft Excel sheet. If the full abstract was unavailable or was ambiguous, the article was complied, obtained and reviewed for inclusion.

Inclusion criteria were (1) original articles describing cases of IRAR due to blunt trauma, (2) basic individual patient data (age, mechanism, clinical presentations, associated injuries, etc.) were presented independently. Institutional studies that reported only incidence were excluded, as well literature reviews. A summary of our methods using the "PRISMA IPD flow diagram for methods and patient selection is illustrated in (Fig. 1).

Fig. 1
figure 1

PRISMA IPD flow diagram for methods and patient selection. IPD, Individual Patient Data

Full size image

Results

A total of 137 titles and abstracts were screened. A total of 47 original articles met the selection criteria. A total of 75 individual patient data was retrieved, including our patient, and compiled for analysis (Table 1) [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47].

Table 1 Results and summary of demographics, sites of rupture, presentations, and outcomes
Full size table

The median age was 26-years and affected all ages, from new-borns to elderly (0–75). The vast majority of cases occurred secondary to a MVA (92%). There are four sites in the RA where IRAR occurs and the Right Atrial Appendage (RAA) was the most common site of rupture (35%). All patients presented with hypotension and physical exam findings suggestive of cardiac tamponade were also common (62%).

There was a statistically significant difference between the averages length of stay (LOS) with each rupture sites, specifically the LOS was doubled when IRAR occurred at the free RA wall. We also observed a statistically significant difference between the rupture sites and whether they present with cardiac tamponade. Specifically, 85% of IRAR at the RAA presented with cardiac tamponade, which could suggest that the location of IRAR may predict presentation (Fig. 2). However, we could not adequately assess this relationship due to the variety of IRAR presentations.

Fig. 2
figure 2

Incidences of cardiac tamponade and hemothorax at different right atrial rupture sites

Full size image

We observed that 28% of IRAR presented with hemothorax and most (74%) were right sided, followed by bilateral hemothorax presentation (Table 2). Median sternotomy was the most commonly used surgical approach (62%) and was observed more when IRAR presented with a right hemothorax.

Table 2 Summary of all cases of isolated right atrial rupture from blunt trauma
Full size table

Discussion

After reporting the first successful repair of a ruptured myocardium by in 1955, Desforges et al. believed that all chambers were equally susceptible to BCR [47]. Unfortunately, this theory was based on limited knowledge of BCRs from reports of sport-related sudden death during baseball games [47]. More recent autopsy studies have challenged this belief after observing that the right heart seemed to be more frequently ruptured [11]. However, autopsy studies do not provide individual patient data that specifically delineates whether or not each ruptured chamber was isolated. Thus, the exact incidence of IRAR is currently unclear and difficult to empirically assess. This study synthesizes a 62-year review of a rare condition with a unique etiology and critically challenging clinical features that may be applied to various settings.

The paucity in the relevant literature could primarily be attributed to IRAR’s high on-scene fatality [4].The vast majority of cases reported a MVA as the source of blunt trauma (Table 1). Other etiologies include, but are not limited to, falls, sports, weight lifting, combat, domestic violence, and more [10]. Of interest, Lu et al. reported a case of a new-born baby that suffered from IRAR due to the high-pressured descent through the vaginal wall during labour, demonstrating the variety of IRAR etiologies [15].

There are no clear risk factors for the IRAR. Although an acute myocardial infarction may increase the risk of cardiac rupture, the incidence of rupture in this population is less than 1%, which makes it very difficult to identify an association [48]. Furthermore, rupture from an infarcted cardiac wall will more likely involve the left ventricular or the interventricular septum, but not the RA [48]. Lastly, we observed that IRAR more commonly affect younger males, although seen in all ages, suggesting a weak correlation between IRAR and history of previous cardiac disease.

The mechanisms of blunt trauma resulting in IRAR are extensively detailed elsewhere [49, 50] (Fig. 3). Though complex, a brief understanding can elucidate more on its etiological heterogeneity. A theory set forth is the “hydraulic effect,” which was first proposed by Leavitt et al. as a mechanism of BCR in 1987 [4]. In summary, the hydraulic effect is a phenomenon observed when an applied force compresses a closed system, thereby decreasing its volume, is accompanied with an increase in pressure. The RA experiences the hydraulic effect on a daily basis during the cardiac cycle, particularly when the atrioventricular valve is closed in late systole [3,4,5]. Sudden increases in venous return can also increase the cardiac intraluminal pressure, which can be observed during normal inspiration, with abdominal compression, or with leg elevation [49]. Once the intraluminal pressure surpasses the cardiac wall elasticity, BCR occurs at the heart’s weakest point, the RA [49, 50].

Fig. 3
figure 3

Flowchart illustrating the physics of right atrium rupture after blunt trauma

Full size image

Another mechanism of BCR that is more unique to IRAR is deceleration forces [50]. When a traveling vehicle abruptly changes direction or stops, the non-fixed, mobile heart will continue to travel in the same initial direction. Once the shearing forces surpass the cardiac elasticity, the RA may tear off the fixed superior vena cava (SVC) and IVC. Shearing forces have been more attributed to RA ruptures involving the fixed venal caval attachment sites, compared to the other two attachment sites [49, 50]. The RAA is the most common site of IRAR and this observation is mainly attributed to its thin wall (Table 1). The RAA’s wall is half as thick (0.53 ± 0.33 mm) comparted to the RA wall (1.11 ± 0.42 mm), making it more susceptible BCR [24].

The diagnosis is one of suspicion and continued hemodynamic instability often prompts the search for a bleeding source. However, many patients with IRAR are initially hemodynamically stable, which has been attributed to the RA’s lower intraluminal pressures. This “static” blood flow creates a more favorable environment for platelet aggregation and may sometimes form an intracardiac hematoma, can mimic the function of a bandage on the rupture site and may be beneficial by transiently decreasing blood loss and may relay a survival benefit [21].

The clinical presentations of BCRs are heterogeneous and vary depending on multiple factors including location and size [12]. Cardiac tamponade is a common feature of BCR and its presence may be an important prognostic factor in IRAR and may have a protective effect on mortality, which was statistically significant [9]. We observed a 6% mortality rate in patients with IRAR if they presented with cardiac tamponade (Table 2). This may be due to increased suspicion of a cardiac etiology when presented with cardiac tamponade, compared to potential delays in diagnosis and time to the operating room, associated with poorer outcomes, in patients that did not present with cardiac tamponade [46]. However, the clinical findings of “Beck’s triad” do not always present together, and up to 35% of cases do not present with cardiac tamponade (Table 1) [17]. Our patient developed profound hypotension but had weak carotid pulses with no jugular venous distension and auscultation of the heart was clear. However, the patient’s rapid hemodynamic decline did not provide enough time for adjunctive testing. Furthermore, there were no findings on FAST suggestive of cardiac tamponade making the diagnosis of rupture more difficult.

Hemothorax is not an uncommon presentation of BCR and is more likely as a result of a concomitant pericardial tear allowing extravasation of fluid into the thoracic cavity [7]. A right hemothorax is more likely with IRAR and the a left hemothorax is almost never present without involvement of the right side. Additionally, hemothorax is a common indication prompting a unilateral thoracotomy. However, median sternotomy is the best method to visualize the RA region as it allows for full visualization of the chest and is better tolerated [46]. Furthermore, up to 82% of blunt cardiac ruptures have associated abdominal injuries, and a median sternotomy may be easily extended into a laparotomy incision for further exploration of the abdomen [5]. We found in our review that most patients (62%) required median sternotomy (Table 2) Moreover, a pericardial window can be performed as a confirmatory test prior to a thoracotomy or a sternotomy and when other tests are inconclusive.

The RA has unique electrophysiological components and more than 80% of blunt cardiac injuries (BCIs) result in dysrhythmias [15]. It is unclear how BCIs causes dysrhythmias, but dysfunction of the vagal sympathetic innervating RA myocytes has been theorized, as well as disruption of the neuromuscular junctions between myocytes [56,57,58]. Furthermore, the type of dysrhythmia may help differentiated between atrial and ventricular injuries. This is because injury to the ventricles is more likely to produce a ventricular tachyarrhythmia or fibrillation. Conversely, RA injury is more likely to develop a bradyarrhythmia due to SA node dysfunction, similar to our patient that presented with profound bradycardia [15, 55].

Electrocardiogram (ECG) lacks specificity in the diagnosis of BCRs, as up to 58% of BCIs result in non-specific ECG changes [51,52,53,54,55]. Other tests, such as cardiac biomarkers (CBMs), have been proposed for the diagnosis of BCRs. However, CBMs also have been shown to lack specificity, as Mahmood et al. observed elevated CBMs in 20% of blunt chest trauma, even in the absence of cardiac involvement [60]. Recently, several studies, including a meta-analysis [54], have suggested the combined use of ECG and CBMs to rule out BCIs and/or monitor its progression [15]. Salim et al. conducted a prospective study of 115 patients with blunt chest trauma and found that both a normal ECG and non-elevation CBMs rules out most cases of BCIs [59]. Furthermore, they suggested that patients with abnormal ECG or CBMs may be monitored for 24–48-h and, with serial CBMs and ECG, be safely discharged in the absence of other injuries [59]. Ultimately, future studies will further elucidate the best role of CBMs in this condition and others.

Conclusion

Based on our review, the isolated right atrial rupture from blunt cardiac trauma is most commonly from blunt traumas during motor vehicle accidents. There are no clear risk factors and the condition most commonly found in younger males. Patients may be initially hemodynamically stable due to smaller tears or hematomas, but clinicians should be cautious with consistent monitoring. Immediate operative intervention should be implemented for hemodynamic instability and short-term outcomes, with favourable outcomes if the condition is promptly managed. The presence of cardiac tamponade may have a protective effect, by increasing suspicion and prompting an investigation for a source of cardiac bleeding. In contrast, hemothorax and other concomitant injuries may worsen outcomes and have a poorer prognosis. The right atrial appendage is the most common location for rupture and may have better outcomes compared to other rupture sites. Further research is indicated as our knowledge of the condition increases.

Abbreviations

BCI:

Blunt cardiac injuries

BCR:

Blunt cardiac rupture

CBMs:

Cardiac biomarkers

FAST:

Focused assessment with sonography for trauma

IPD:

Individual Patient Data

IRAR:

Isolated right atrial rupture

IVC:

Inferior vena cava

LOS:

Length of stay

MVA:

Motor vehicle accident

RA:

Right atrium

RAA:

Right Atrial Appendage

SVC:

Superior vena cava

References

  1. Kulshrestha P, Das B, Iyer KS, Sampath KA, Sharma ML, Rao IM, et al. Cardiac injuries-a clinical and autopsy profile. J Trauma. 1990;30:203–7 2304116.

    Article  CAS  Google Scholar 

  2. Teixeira PGR, Inaba K, Oncel D, DuBose J, Chan L, Rhee P, et al. Blunt cardiac rupture: a 5-year NTDB analysis. J Trauma Injury Infect Crit Care. 2009;67:788–91. https://doi.org/10.1097/TA.0b013e3181825bd8.

    Article  Google Scholar 

  3. Martin TD, Flynn TC, Rowlands BJ. Blunt cardiac rupture. J Trauma. 1984;24:287–90.

    Article  CAS  Google Scholar 

  4. Leavitt BJ, Meyer JA, Morton JR, Clark DE, Herbert WE, Hiebert CA. Survival following nonpenetrating traumatic rupture of cardiac chambers. Ann Thorac Surg. 1987;44:532–5.

    Article  CAS  Google Scholar 

  5. Tobin HM, Hiratzka LF, Vargish T. Ruptured right atrium from nonpenetrating trauma of the chest. South Med J. 1986;79(4):499–501.

    Article  CAS  Google Scholar 

  6. Roland J, Seoudi HM, Albus RA, Fakhry SM. Right atrial rupture from blunt thoracic trauma in a 4-year-old child. Pediatr Emerg Care. 2009;25(3):188–9. https://doi.org/10.1097/PEC.0b013e31819a8b95.

    Article  PubMed  Google Scholar 

  7. Getz BS, Davies E, Steinberg SM, Beaver BL, Koenig FA. Blunt cardiac trauma resulting in right atrial rupture. JAMA. 1986;255(6):761–3 3944977.

    Article  CAS  Google Scholar 

  8. De giorgio F, Abbate A, Capelli A, Arena V. Right atrium tear as cause of death after blunt chest trauma. Injury. 2006;37(1):81–2. https://doi.org/10.1016/j.injury.2005.03.014.

    Article  PubMed  Google Scholar 

  9. Lajevardi SS, Galougahi KK, Nova G, Marshman D. Surviving right atrial rupture from blunt thoracic trauma after Pericardiectomy. Ann Thorac Surg. 2016;101(2):749–52. https://doi.org/10.1016/j.athoracsur.2015.04.083.

    Article  PubMed  Google Scholar 

  10. Yun JH, Byun JH, Kim SH, et al. Blunt traumatic cardiac rupture: single-institution experiences over 14 years. Korean J Thorac Cardiovasc Surg. 2016;49(6):435–42. https://doi.org/10.5090/kjtcs.2016.49.6.435.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Al ayyan M, Aziz T, El sherif A, Bekdache O. Blunt cardiac injury: case report of salvaged traumatic right atrial rupture. Ulus Travma Acil Cerrahi Derg. 2015;21(6):527–30. 27054650.

    PubMed  Google Scholar 

  12. Pinni S, Kumar V, Dharap SB. Blunt cardiac rupture: a diagnostic challenge. J Clin Diagn Res 2016;10(11):PD27-PD28. DOI: https://doi.org/10.7860/JCDR/2016/22220.8894.

  13. Chen SW, Huang YK, Liao CH, Wang SY. Right massive haemothorax as the presentation of blunt cardiac rupture: the pitfall of coexisting pericardial laceration. Interact Cardiovasc Thorac Surg. 2014;18(2):245–6. https://doi.org/10.1093/icvts/ivt483.

    Article  PubMed  Google Scholar 

  14. Gromadziński L, Zelazny P, Pruszczyk P. Right atrial rupture following a blow with a wooden block in the sternal region. Kardiol Pol. 2014;72(1):88. https://doi.org/10.5603/KP.2014.0014.

    Article  PubMed  Google Scholar 

  15. Telich-tarriba JE, Anaya-ayala JE, Reardon MJ. Surgical repair of right atrial wall rupture after blunt chest trauma. Tex Heart Inst J 2012;39(4):579–581. PMID: 22949784.

  16. Misao T, Yoshikawa T, Aoe M, et al. Bronchial and cardiac ruptures due to blunt trauma. Gen Thorac Cardiovasc Surg. 2011;59(3):216–9. https://doi.org/10.1007/s11748-010-0638-3.

    Article  PubMed  Google Scholar 

  17. Lu WH, Chen YY, Pan JY, Wang HP, Chang JT, Hsieh KS. Hemopericardium from right atrial laceration in a newborn. J Chin Med Assoc. 2011;74(9):423–4. https://doi.org/10.1016/j.jcma.2011.08.009.

    Article  PubMed  Google Scholar 

  18. Gajjar A, Atherton J. Isolated right atrial tear following blunt trauma. J Surg Case Rep. 2011;2011(8):8. https://doi.org/10.1093/jscr/2011.8.8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Colonna AL, Enniss TM, Meredith JW, Hildreth AN. Celiac artery avulsion and right atrial rupture after blunt multisystem trauma. Am Surg 2010;76(7):E83–E85. PMID: 21683006.

  20. Diodato MD, Grammer M, Beilman G, Manshaii S. Surviving right atrial rupture. Am Surg 2009;75(6):522–523. PMID: 19545108.

  21. Hakuba T, Minato N, Minematsu T, Kamohara K. Surgical management and treatment of a traumatic right atrial rupture. Gen Thorac Cardiovasc Surg. 2008;56(11):551–4. https://doi.org/10.1007/s11748-008-0294-z.

    Article  PubMed  Google Scholar 

  22. Souteyrand G, Combes S, Dauphin C, et al. Right atrial tear associated with a tumour in the right atrium after blunt chest trauma. Eur J Echocardiogr. 2008;9(1):116–8. https://doi.org/10.1016/j.euje.2007.03.046.

    Article  PubMed  Google Scholar 

  23. De maria E, Gaddi O, Navazio A, Monducci I, Tirabassi G, Guiducci U. Right atrial free wall rupture after blunt chest trauma. J Cardiovasc Med (Hagerstown). 2007;8(11):946–9. https://doi.org/10.2459/JCM.0b013e328013f8af.

    Article  Google Scholar 

  24. Figueiredo AM, Poggetti RS, Quintavalle FG, et al. Isolated right atrial appendage (RAA) rupture in blunt trauma--a case report and an anatomic study comparing RAA and right atrium (RA) wall thickness. World J Emerg Surg. 2007;2(5). https://doi.org/10.1186/1749-7922-2-5.

  25. Hirai S, Hamanaka Y, Mitsui N, Isaka M, Kobayashi T. Successful emergency repair of blunt right atrial rupture after a traffic accident. Ann Thorac Cardiovasc Surg 2002;8(4):228–230. PMID: 12472388.

  26. Grande AM, Rinaldi M, Pasquino S, Dore R, Viganò M. Nonpenetrating right atrial and pericardial trauma. Ann Thorac Surg 2003;76(3):923–925. PMID: 12963232.

  27. Fujiwara K, Naito Y, Komai H, Yokochi H, Enomoto K, Shinozaki M. Right atrial rupture in blunt chest trauma. Jpn J Thorac Cardiovasc Surg. 2001;49(7):476–8 11517588.

    Article  CAS  Google Scholar 

  28. Degiannis E, Brink J, Haagensen M, Williams P, Boffard K. Rupture of the auricle of the right atrium of the heart and pericardium after blunt trauma. Eur J Surg. 2001;167(6):472–4. https://doi.org/10.1080/110241501750243879.

    Article  CAS  PubMed  Google Scholar 

  29. Fang BR, Kuo LT, Li CT, Chang JP. Isolated right atrial tear following blunt chest trauma: report of three cases. Jpn Heart J 2000;41(4):535–540. PMID: 11041105.

  30. Symbas NP, Bongiorno PF, Symbas PN. Blunt cardiac rupture: the utility of emergency department ultrasound. Ann Thorac Surg. 1999;67(5):1274–6.

    Article  CAS  Google Scholar 

  31. Fulton JO, Nel L, De Groot KM, Von Oppell UO. Blunt cardiac rupture. S Afr J Surg. 1998;36(4):132–5.

    CAS  PubMed  Google Scholar 

  32. Song MH, Shimomura T, Tajima K, Suenaga Y. Blunt cardiac trauma: successful repair of right atrium rupture. J Cardiovasc Surg. 1998;39(4):473–4.

    CAS  Google Scholar 

  33. Tassiopoulos AK, Carlin RE, Dibos L, Mcgraw DJ. Cardiac rupture due to blunt trauma. South Med J. 1997;90(7):740–2.

    Article  CAS  Google Scholar 

  34. Fang BR, Chang JP, Chang CS. Blunt chest trauma causing right atrial tear, hemopericardium and cardiac tamponade successfully treated with cardiorrhaphy. Int J Cardiol. 1993;38(2):193–5.

    Article  CAS  Google Scholar 

  35. Jain SK, Hamdy MG, Garg MC. Double right atrial tear in blunt cardiac trauma. Injury. 1993;24(9):623–4.

    Article  CAS  Google Scholar 

  36. Fonner BT, Vogelzang RL. Right atrial rupture due to blunt trauma: CT evaluation. Comput Med Imaging Graph. 1992;16(1):27–9.

    Article  CAS  Google Scholar 

  37. Nirgiotis JG, Black CT. Blunt rupture of the heart in a child. Tex Med. 1991;87(11):83–5.

    CAS  PubMed  Google Scholar 

  38. Schiavone WA, Ghumrawi BK, Catalano DR, et al. The use of echocardiography in the emergency management of nonpenetrating traumatic cardiac rupture. Ann Emerg Med. 1991;20(11):1248–50.

    Article  CAS  Google Scholar 

  39. Griffith GL, Zeok JV, Mattingly WT, Todd EP. Right atrial rupture due to blunt chest trauma. South Med J. 1984;77(6):715–6.

    Article  CAS  Google Scholar 

  40. Dimarco RF, Layton TR, Manzetti GW, Pellegrini RV. Blunt traumatic rupture of the right atrium and the right superior pulmonary vein. J Trauma. 1983;23(4):353–5.

    Article  CAS  Google Scholar 

  41. Galton BB. Tear of right atrial appendage following blunt chest wall trauma. J Med Soc N J. 1977;74(12):1066–8.

    CAS  PubMed  Google Scholar 

  42. O'sullivan MJ, Spagna PM, Bellinger SB, Doohen DJ. Rupture of the right atrium due to blunt trauma. J Trauma. 1972;12(3):208–14.

    Article  Google Scholar 

  43. Desforges G, Ridder WP, Lenoci RJ. Successful suture of ruptured myocardium after nonpenetrating injury. N Engl J Med. 1955;252(14):567–9.

    Article  CAS  Google Scholar 

  44. Miller GE, Rueb AE. Blunt thoracic trauma producing heart laceration. Case report. Ann Surg. 1967;166(5):852–3.

    Article  CAS  Google Scholar 

  45. Borja AR, Lansing AM. Traumatic rupture of the heart: a case succesfully treated. Ann Surg. 1970;171(3):438–40.

    Article  CAS  Google Scholar 

  46. Trueblood HW, Wuerflein RD, Angell WW. Blunt trauma rupture of the heart. Ann Surg. 1973;177(1):66–9.

    Article  CAS  Google Scholar 

  47. Siderys H, Strange PS. Rupture of the heart due to blunt trauma. Successful treatment utilizing cardiopulmonary bypass J Thorac Cardiovasc Surg. 1971;62(1):84–6.

    CAS  PubMed  Google Scholar 

  48. Becker RC, Gore JM, Lambrew C, et al. A composite view of cardiac rupture in the United States National Registry of myocardial infarction. J Am Coll Cardiol. 1996;27(6):1321–6.

    Article  CAS  Google Scholar 

  49. Beck CS, Bright EF. Changes in the heart and pericardium brought about by compression of the legs and abdomen. J Thorac surg. 1933;2:616–28.

    Google Scholar 

  50. Daffner RH, Deeb ZL, Lupetin AR, Rothfus WE. Patterns of high-speed impact injuries in motor vehicle occupants. J Trauma. 1988;28(4):498–501.

    Article  CAS  Google Scholar 

  51. El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med. 2008;35(2):127–33.

    Article  Google Scholar 

  52. Parr MJ. Blunt cardiac injury. Minerva Anestesiol. 2004;70(4):201–5.

    CAS  PubMed  Google Scholar 

  53. Alborzi Z, Zangouri V, Paydar S, et al. Diagnosing myocardial contusion after blunt chest trauma. J Tehran Heart Cent. 2016;11(2):49–54.

    PubMed  PubMed Central  Google Scholar 

  54. Maenza RL, Seaberg D, D’Amico F. A meta-analysis of blunt cardiac trauma: ending myocardial confusion. Am J Emerg Med. 1996;14(3):237–41.

    Article  CAS  Google Scholar 

  55. Vougiouklakis T, Peshos D, Doulis A, et al. Sudden death from contusion of the right atrium after blunt chest trauma: case report and review of the literature. Injury. 2005;36(1):213–7.

    Article  Google Scholar 

  56. Williams JC, Elkington WC. Slow progressing cardiac complications-a case report. J Chiropr Med. 2008;7(1):28–33.

    Article  Google Scholar 

  57. Viano DC, Artinian CG. Myocardial conducting system dysfunction from thoracic impact. J Trauma. 1978;18(6):452–9.

    Article  CAS  Google Scholar 

  58. Stein PD, Sabbah HN, Viano DC, Vostal JJ. Response of the heart to nonpenetrating cardiac trauma. J Trauma. 1982;22(5):364–73.

    Article  CAS  Google Scholar 

  59. Salim A, Velmahos GC, Jindal A, Chan L, Vassiliu P, Belzberg H, Asensio J, Demetriades D. Clinically significant blunt cardiac trauma: role of serum troponin levels. J Trauma. 2001;50(2):237–43.

    Article  CAS  Google Scholar 

  60. Mahmood I, El-Menyar A, Dabdoob W, Abdulrahman Y, Siddiqui T, Atique S, et al. Troponin T in patients with traumatic chest injuries with and without cardiac involvement: insights from an observational study. N Am J Med Sci. 2016;8(1):17–24.

    Article  Google Scholar 

Download references

Acknowledgements

None.

Funding

Not applicable.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author information

Authors and Affiliations

  1. Trauma Department, Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA

    Tareq Maraqa, Vinu Perinjelil, Gul R. Sachwani-Daswani & Leo Mercer

  2. Department of Surgery, Michigan State University College of Human Medicine, Eyde Building, Suite 600, 4660 S. Hagadorn Road, East Lansing, MI, 48823, USA

    Mohamed A. T. Mohamed

  3. Department of Surgery, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Kenneth L. Wilson

Authors
  1. Tareq Maraqa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed A. T. Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth L. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vinu Perinjelil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gul R. Sachwani-Daswani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leo Mercer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TM, MM, KW and VP, provided critical input on the conception, design, and revision of the manuscript. GSD and LM provided critical revisions for the submission of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tareq Maraqa.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maraqa, T., Mohamed, M.A.T., Wilson, K.L. et al. Isolated right atrial rupture from blunt trauma: a case report with systematic review of a lethal injury. J Cardiothorac Surg 14, 28 (2019). https://doi.org/10.1186/s13019-019-0836-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13019-019-0836-8

Keywords

Journal of Cardiothoracic Surgery

ISSN: 1749-8090

Contact us