右室乳頭筋断裂を合併した外傷性右房破裂

Traumatic Right Atrial Rupture and Right Ventricular Papillary Muscle Rupture

外傷性心破裂は交通事故によるものが約半数を占め，そのほとんどが多発外傷合併例であることから，救命率は20％未満と低い．

A 18-year-old man was driving at 100 km/h on a motorbike and collided with a utility pole. He was taken to our hospital in a state of shock due to an unstable pelvic fracture and cardiac tamponade. Pericardial drainage was carried out, but intrapericardial hemorrhage persisted and the patient underwent emergency thoracotomy and suture of right atrial injury. After hemodynamic condition improved, the patient was transferred to a tertiary care facility. For the pelvic fracture, open reduction and fixation was performed on the 6th day after injury. During recovery, moderate mitral valve regurgitation and severe tricuspid valve regurgitation due to rupture of the right ventricular papillary muscle were diagnosed. The patient’s exercise tolerance was too reduced to continue rehabilitation. Thirty-seven days after the injury, mitral and tricuspid valve repair was performed. Four months after the injury, he was discharged without sequelae.