[Traumatic Right Atrial Rupture and Right Ventricular Papillary Muscle Rupture].

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.

[Partial Rupture of an Anterior Papillary Muscle without Preoperative Diagnosis of Acute Myocardial Infarction;Report of a Case].

We report a case of partial rupture of an anterior papillary muscle without diagnosis of acute myocardial infarction before operation. A 70-year-old woman who had been in the psychiatry department for schizophrenia was admitted to our hospital by emergency for shock and dyspnea. Echocardiography demonstrated severe mitral regurgitation with prolapse of the anterior leaflet, and coronary angiography revealed significant stenosis of the 1st diagonal branch but no total occlusion of the coronary artery. In an emergency operation, partial rupture of the anterior papillary muscle and thickening of the posterior leaflet were found, and mitral valve repair was performed. Her postoperative course was uneventful. Postoperative pathological examination revealed acute myocardial infarction.

Aortic valve replacement for aortic regurgitation with rare left ventricular non-compaction.

Left ventricular noncompaction cardiomyopathy is a rare type of congenital cardiomyopathy characterized by prematurely arrested compaction of the endocardial and myocardial fibers and the progressive deterioration of left ventricular contractility. This entity is a genetically heterogeneous disorder and has a wide spectrum of presentation from no symptoms to critical disabling congestive heart failure, which can appear at any age. The prognosis is therefore varied. An elderly patient with left ventricular noncompaction underwent aortic valve replacement for associated aortic regurgitation.Follow-up at two years after surgery revealed an improved clinical condition and recovered cardiac function. This is the fourth known aortic valve replacement in a patient with left ventricular noncompaction.

[Successful repair of blunt right atrial rupture; report of a case].

A 58-year-old male was compressed between 2 trucks during a traffic accident, and was brought to a local hospital with chest and back pain. Computed tomography showed pericardial effusion, and pericardiocentesis was performed. As cardiac rupture was suspected by the aspiration of blood, the patient was immediately transferred to our hospital. Pericaridocentesis was performed again with the introduction of a 7F sheath to release cardiac tamponade because the patient suddenly lost consciousness and showed respiratory arrest with shock just after arrival. After recovery from shock, the patient underwent median sternotomy. Surgery was performed without using cardiopulmonary bypass, and the rupture site in the right atrium was closed by direct surtures. The patient recovered without cardiac event and was discharged on the 46th postoperative day.