Abstract 18703: No Time for Horseplay: A Case on a Traumatic Septal Defect

Abstract

Background: A 74-year-old male with no past medical history presented to the clinic due to shortness of breath that had worsened over the past two weeks. He reports being “knocked over by a horse” about one month before and experienced chest pain immediately afterwards. A new holosystolic murmur was found prompting further evaluation. A walking test showed his oxygen saturation dropped from 98% to 81% on room air and was in respiratory distress. TTE revealed a large VSD of 1.5 cm with a left to right shunt, a dilated right ventricle measured at 4.9 cm, and severe pulmonary hypertension. Coronary angiography ruled out a prior myocardial infarction. RHC revealed an increase of oxygen saturation from the right atrium at 68.6% to 92% in the right ventricle. The patient was transferred to a facility where he underwent successful surgical VSD closure. He was discharged to rehab on post-operative day 8. He presented to the clinic one month later reporting resolution of his symptoms. Discussion: This patient with no past cardiac history presented with progressive dyspnea that was later identified to be caused by a trauma he experienced one month prior. The incidence of traumatic VSDs is quite low. Most VSDs are congenital in nature however few are reported to be trauma related. Trauma so intense that could cause a rupture in the septal muscle is quite intriguing. Prompt work up with imaging modalities such as TTE is the best next step for any trauma-related symptoms. Shared decision making with the patient and a multidisciplinary team will help to decide on a percutaneous or surgical repair of the defect. This case demonstrated a systematic approach to a unique presentation of a typically congenital condition.