Case Report
Coronary Artery Bypass Surgery in Undiagnosed Traumatic Pericardial Rupture—25 Years Later

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A 55-year-old man was electively admitted for coronary artery bypass surgery. His admission chest X-ray showed an abnormal cardiac silhouette with complete leftward displacement. He had a past history of blunt thoracic trauma due to a motor vehicle accident treated conservatively. We present our findings and surgical difficulty during an operation on a patient with a previously undiagnosed pericardial rupture. This is the first reported case of its kind in the cardiac surgical literature.

Introduction

Traumatic rupture of pericardium is rare and usually associated with other major injuries with a mortality ranging from 30% to 65%. This condition presents a diagnostic and management dilemma.

Section snippets

Case Report

A 55-year-old man was admitted to the hospital for elective coronary artery bypass surgery for increasing exertional angina. He had a past history of blunt thoracic trauma following a motor vehicle accident sustained 25 years ago. During that accident, he had suffered from fractured ribs on the left side and a dislocated left shoulder, which was treated conservatively with a few days admission in hospital.

His physical examination showed that the apex beat was laterally displaced towards the

Discussion

This patient must have sustained a left pleuropericardial rupture during the initial trauma which remained undiagnosed. Gradually the heart must have herniated into the left chest without causing any hemodynamic compromise.

Traumatic pericardial rupture presents with diagnostic and management problems. Review of the literature1, 2 shows the following: the incidence of traumatic pericardial rupture is 1 in 1000 patients admitted to a trauma centre. Eighty percent of cases were diagnosed

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  • G. Fulda et al.

    Blunt traumatic pericardial rupture. A ten-year experience 1979 to 1989

    J Cardiovasc Surg

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