Isolated rupture of the interventricular septum due to a fall from a height

Abstract

Isolated ventricular septal defect (VSD) is a very rare isolated VSD. To our knowledge, this is only the second complication of blunt chest trauma. Cardiac injuries following blunt chest trauma usually result from motor vehicle accidents. We present the unusual case of an isolated rupture of the interventricular septum after a fall from a height. A previously healthy 25-year-old construction worker was admitted to hospital after a fall from a height of 10 m. Physical examination revealed no visible signs of chest wall injury. He was hemodynamically stable with a pulse rate of 130 bpm and BP of 115/65. Cardiac examination did not reveal any murmurs. He sustained fractures of the right femur, left clavicle and facial bones. There were no sternal or rib fractures. Eight hours later, a loud pansystolic murmur (4/6) was heard along the left sternal border. ECG showed STelevation in the anteroseptal leads (Fig. 1). Troponin I was elevated at 6.9 Ag/l (normal < 0.33 Ag/l). Transthoracic echocardiogram revealed a 4 mm apical VSD (Fig. 2). Continuous wave Doppler demonstrated a left to right shunt with a peak velocity of 4.8 m/s. The calculated pulmonary to systemic flow ratio (Qp/Qs) was 1.4 to 1. Pulmonary artery systolic pressure was 44 mm Hg. Left ventricular systolic function was normal with an ejection fraction of 55%. Cardiac chambers were not dilated. A clinical diagnosis of traumatic VSD due to myocardial contusion was made. As the patient remained stable without evidence of heart failure, he was managed conservatively. He received infective endocarditis antibiotic prophylaxis during orthopaedic surgery. He made an uneventful recovery and was discharged with cardiology clinic follow up. Isolated VSD after blunt chest trauma is extremely rare. Parmley et al. [1] reviewed the autopsy findings of 5467 cases of blunt chest trauma and found only five cases of