PENETRATING HEART INJURY AFTER A CLOSED T HORACIC TRAUMA

A 60-year-old man, was admitted in the emergency ward, following a mot or vehicle accident. At the time of arrival his clinical state was sta ble. The initial investigations showed a moderate left haemopneumothor ax and fractured ribs. After insertion of a thoracostomy tube into the left pleural cavity he had to undergo surgery for an open facture of the left arm. Following induction of anaesthesia, a cardiovascular col lapse occurred rapidly. An emergency thoracotomy was performed which s howed a right ventricular perforation by a rib fragment. The authors d iscuss the role of possible changes in heart position produced by indu ction of general anaesthesia. Indeed the decrease in functional residu al capacity following induction of anaesthesia with a cephalad diaphra gmatic shift may have secondarily exposed the right ventricle to the b evel of a fractured rib.