Eur J Cardiothorac Surg 2001;19:215
© 2001 Elsevier Science NL
Images in cardio-thoracic surgery |
Traumatic pericardial rupture with a right dislocation of the heart
Amine Hadjkacema,
Olivier Chavanona,
Rachid Hacinia,
Dominique Blina
a Department of Cardiac Surgery, Grenoble University Hospital, Grenoble, France
Received 27 June 2000;
received in revised form 10 November 2000;
accepted 17 November 2000.
Corresponding author. Service de Chirurgie Cardiaque, CHU Grenoble, BP 217 Grenoble Cedex 9, France. Tel.: +33-4-7676-5462; fax: +33-4-7676-5264
Key Words: Heart dislocation • Pericardial defect • CT scan • Sternotomy
A 35-year-old man was admitted for multiple trauma following a violent skiing accident. He complained from chest and abdominal pain and had a paraplegia. On clinical examination, the apex beat and the heart sound were perceived on the right side of the chest. Diagnosis was confirmed by chest X-rays (Fig. 1) and thoracoabdominal CT scan (Fig. 2). Surgical exploration via sternotomy revealed a total hemiation of the heart through a large tear (15 cm) of the right pericardium, in front of and behind the intact right phrenic nerve. After reducing the heart dislocation, closure of the pericardial defect was performed using a Gore-Tex® Soft Tissue Patch (Gore & Associates, Flagstaff, AZ, USA). The cardiac evolution was uneventful but respiratory failure occurred due to right phrenic paresis with atelectasis and pulmonary surinfection, requiring a prolonged ventilatory assistance until postoperative day 28.
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Fig. 1. Chest X-rays: fracture of the left clavicle, multiple rib fractures, left pneumothorax, right hemothorax, dextro positioned heart.
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Fig. 2. Thoracic CT-scan: right dislocation of the heart, bilateral hemopneumothorax predominant on the left side.
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Acknowledgments
We thank Dr P.E. Colle for revision of the manuscript.
