Survival following blunt traumatic right ventricular free wall rupture

We present a case of survival after ventricular wall rupture in a young man following a fall. The patient had a delayed presentation to the emergency department with normotension and a slight tachycardia. His complaints were mild dyspnea with thoracic pain. Computed tomography of his chest revealed a pericardial effusion, a right ventricular wall defect with pseudoaneurysm and active contrast extravasation. He was transferred to our tertiary care institution for emergent cardiac intervention. The patient had a unique past surgical history significant for previous median sternotomy as a child for repair of a patent foramen ovale at the age of 13 years. Upon arrival to our facility, the patient underwent surgical exploration, and a transmural defect was identified in the right ventricle. This was repaired on cardiopulmonary bypass, and the patient recovered well. Cardiac injury following blunt thoracic trauma should always be considered when a patient presents with hypotension and tachycardia. Expeditious diagnosis and intervention is required for salvage. We believe our patient’s past surgical history with previous pericardiotomy directly contributed to his survival of a typically lethal injury.