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The cases of eight patients who underwent elective surgery for blunt cardiac trauma are presented. All but one experienced multiple trauma and the median Injury Severity Score was 26 (range, 18-59). A posttraumatic cardiac defect was diagnosed from 1 day up to 6.5 years (median, 3 weeks) after the accident. These included mitral regurgitation (n = 4), ventricular septal defect (n = 2), atrial septal defect with mitral regurgitation (n = 1), and ventricular aneurysm (n = 1). Elective cardiac surgery was performed from 4 weeks up to 12 years after the traumatic event (median, 18.5 months). A history of blunt chest trauma requires careful clinical follow-up supported by echocardiography in asymptomatic patients. Surgical therapy is performed according to standard techniques and the results are comparable with those of non-trauma surgery.

Between 1972 and 1990 11 patients--all but one of them with multiple injuries--were treated surgically for blunt cardiac trauma caused by traffic accident in about 90%. Myocardial rupture (n = 3), laceration of the pericardial sac (n = 1), mitral insufficiency (n = 5; one of them in combination with atrial septal defect), ventricular septal defect (n = 1) and myocardial aneurysm (n = 1) occurred. Patients with myocardial rupture and pericardial laceration died within 2 h after admission to hospital; the other patients were successfully treated by mitral valve replacement (n = 4), mitral valvuloplasty and repair of ASD, suture repair of VSD and resection of myocardial aneurysm in one case, respectively. The interval to operation was 8 months to 12 years. Whereas pericardial tamponade caused by rupture of the atrial or ventricular wall and injuries of main coronary vessels require immediate surgical intervention, valve insufficiencies, septal defects or myocardial aneurysms may be mostly treated at a later date. Improvement of logistic measurements and the suspicion of blunt cardiac trauma followed by immediate surgical intervention may reduce the mortality rate in cases of cardiac rupture.

The histories of 66 patients with blunt abdominal trauma requiring surgery in the period from 1985 to 1989 were analysed. The patients were divided into three groups on the basis of the other injuries present. Group I, isolated blunt abdominal trauma and blunt abdominal trauma with slight concomitant injuries (18 patients, ISS 17.17 +/- 1.40); group II, blunt abdominal trauma with severe concomitant injuries but without craniocerebral trauma (23 patients, ISS 29.34 +/- 1.45); and group III, blunt abdominal trauma with severe concomitant injuries and an additional craniocerebral trauma (25 patients, ISS 31.08 +/- 1.27, GCS: 10.04 +/- 0.88). Initially, the diagnosis was made in 23 cases by means of diagnostic peritoneal lavage and in 43 cases by means of sonography. The subsequent laparotomy revealed the ultrasound findings to have been false-positive in 3 cases. No false-negative ultrasound findings were demonstrated at all. Peritoneal lavage, on the other hand, was found to have yielded false-negative and false-positive findings in 2 cases each. Counting from the time of admission, the time up to diagnosis of the intra-abdominal injury was 85 +/- 14.3 min in group I, 82 +/- 9.9 min in group II, and 86 +/- 12.9 min in group III. Thus, the presence of severe additional injuries did not lead to any significant delay in the diagnosis of blunt abdominal injury requiring surgery. The total mortality rate was 18.18% (group I, 11.1%; group II, 21.7%; group III, 20.0%). Six patients died in the acute phase and a further six patients during their stay on the intensive care ward.