Post traumatic left cardiac luxation: A case report. (2020)

• Record Type: Journal Article
• Authors: Lajmi, Mokhles; Ben Ismail, Imen; Ragmoun, Wafa; Messaoudi, Houssem; Lahdhili, Hatem; Chenik, Slim
• Is Part Of: International journal of surgery case reports. Volume 71(2020)
• Page Start: 205
• Page End: 208
• Publication Date: 2020
• Subjects: Pericardial rupture -- Cardiac luxation -- Median sternotomy; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.04.095
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Luxation of the heart after blunt thoracic trauma is an exceedingly rare condition. Traumatic pericardial rupture results in luxation of the heart. If undetected it has a high mortality rate. CT scan is the diagnostic method of choice in hemodynamically stable patients. Surgical approach is dictated by the surgeon's experience and associated lesions. Abstract: Introduction: Rupture of the pericardium complicating blunt thoracic trauma may lead to cardiac luxation if not early recognized and appropriately surgically treated. This condition is exceedingly rare and carries a high mortality rate. Case presentation: A 37-year-old man presented with severe multiple injuries following a road traffic crash, including blunt trauma to the thorax and abdomen. He was in a hemodynamically stable condition. The chest radiograph and CT scan revealed a leftward heart herniation through a pericardial tear, there were also non surgical hepatic and splenic lesions. The diagnosis of left cardiac luxation with no associated valvular lesions was made. Surgical exploration via a midline sternotomy revealed a protruding heart herniating into the left pleural cavity through a large tear (15 cm) of the left pericardium. Sutures with Teflon felt pledgets were performed. The postoperative chest radiograph was normal and the postoperative course was uneventful. Discussion: Post traumatic heart luxation diagnosis is clinically difficult because the scarcity of signs and lack of specificity. Chest X ray can be suggestive, and specific findings can only be detected by computed tomography, which is the most sensitive diagnostic method. Surgical management in this condition is mandatory to avoid fatal complications such as great vessels strangulation. It consists of replacing the heart in the pericardial sac and repairing the pericardial tear. Conclusion: Despite its rare occurrence, trauma surgeons must be aware of cardiac luxation. Any suspicion of such a diagnosis would warrant surgical exploration to avoid fatal complications.