Clamshell Thoracotomy for Two Cases of Blunt Traumatic Cardiac Rupture

Takahisa Miki

（Critical Care Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan）

When a sufficient field of view in unilateral thoracotomy cannot be obtained during hemostasis surgery for severe thoracic trauma, clamshell thoracotomy is often necessary to perform aortic cross-clamping in order to avoid cardiac arrest or to treat intrathoracic injury across the chest. Here we describe two successful cases of clamshell thoracotomy for blunt traumatic cardiac rupture. Case 1 was a 41-year-old male motorcyclist, injured in a collision with a truck, who was in a state of shock when transported to our emergency department（ED). Due to the finding of fluid accumulation around the spleen on FAST（focused assessment with sonography for trauma), he underwent emergency laparotomy with gauze packing after splenectomy as damage control surgery. Because of a prolonged state of shock due to extensive right hemothorax, right anterolateral thoracotomy was performed to locate the site of active bleeding in the right mediastinal pleura. However, imminent cardiac arrest necessitated clamshell thoracotomy, which revealed a 4-cm laceration on the right atrium and two lacerations on the upper lobe of the right lung, for which suture repair was performed. His postoperative course was uneventful and he was discharged on postinjury day 57 for rehabilitation. Case 2 was a 75-year-old female motorcyclist who was injured after hitting a curb and falling. She was in a state of shock due to severe right hemothorax when admitted to our ED and underwent anterolateral thoracotomy to treat active bleeding in the right mediastinal pleura. Clamshell thoracotomy was performed because cardiac arrest was imminent, and this was followed by suture repair of a 2-cm laceration identified on the left atrium. Her postoperative course was uneventful and she was transferred to another hospital on postinjury day 37 for rehabilitation. In both cases, Clamshell thoracotomy was performed successfully for blunt traumatic cardiac rupture and the postoperative course was good with no serious complications. Clamshell thoracotomy is an effective approach for trauma resuscitation, so surgeons should be familiar with its indications, surgical techniques, and timing.

 

Jpn. J. Cardiovasc. Surg. 43:230-233（2014）

Keywords：blunt cardiac trauma;cardiac rupture;Clamshell thoracotomy;descending aortic cross-clamping;hilar cross-clamping