Cardiac Laceration and Rupture

The anterior surface of the heart, underlying the chest wall, is composed as follows: 55% right ventricle, 20% left ventricle, 10% right atrium, 10% ascending aorta and pulmonary artery and 5% vena cavae (205). The frequency of cardiac rupture sites mirrors the surface anatomy (129,206,217-220). Septal ruptures are relatively uncommon.

Fig. 31. Myocardial contusion (delimited by arrows).

Atrial rupture most likely happens when the heart is squeezed during systole (204). Survivability is most likely with an atrial tear (206,209,219,221-223). Ventricular rupture occurs from a precordial blow during diastole (204,224). Other mechanisms of cardiac rupture include increased pressure caused indirectly by abdominal and extremity trauma, and deceleration (224-226). Cardiac lacerations can heal forming ventricular aneurysms (227). Cardiac aneurysms are complicated by rupture, congestive heart failure, arrhythmia, and systemic emboli. Delayed rupture can occur during healing (225,228).

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