Right Luxation of the Heart after Pericardial Rupture Caused by Blunt Trauma

To the Editor:

We read with great interest the recent article of De Amicis and co-authors concerning right luxation of the heart. ¹ In the authors' discussion, references to clinical and electrocardiographic symptoms are limited. Even though the clinical signs are not specific after chest trauma, they can indicate pericardial lesions. ² Therefore, on cardiac examination, pericardial mur mur or a “bruit du moulin” may be a symptom of an uncomplicated pericardial rupture. Hemodynamic -instability during cardiac herniation can suggest an -extrapericardial luxation. ³ In some cases, when a central intravenous line was previously inserted, a spontaneous increase of central venous pressure has been observed in right post-traumatic extrapericardial luxation of the heart. The analysis of electrocardiograms for patients with chest trauma is also revealing, in particular when repeated. The electrocardiogram is now considered as a routine and necessary exam for chest trauma. ³ If some findings are nonspecific, such as arrhythmia, repolarization abnormalities, right bundle branch block, etc., an axis deviation can mean a cardiac malposition. ⁴

As the authors point out, ¹ the importance of repeated chest radiography and transthoracic echocardiography must not be forgotten. The chest radiograph can show a right cardiac herniation, an apparent enlargement of the heart, or a pneumopericardium. The transthoracic or transesophageal echocardiogram can show compression of the left atrium. Therefore, these exams should be per formed immediately and repeated serially if needed.

In conclusion, even if computed tomography and angiography confirm the diagnosis, careful investigation of other signs, especially clinical, is essential. And we highlight the fact that computed tomographic and radiologic exams must be repeated whenever clinical change occurs.