Traumatic Ventricular Septal Defect Research Articles

Interval Surgery for Unstable Traumatic Ventricular Septal Defect

Blunt or penetrating thoracic wall trauma can lead to formation of a traumatic ventricular septal defect. This is a serious cardiac complication that can have dire hemodynamic consequences in a setting of ongoing hemorrhage. This demands urgent surgical repair to cease further deterioration. We describe a patient with traumatic VSD who underwent successful interval repair after management of acute abdomen and stabilization of hemodynamics using vasopressors and Intra-Aortic Balloon Pump (IABP). Keywords: Traumatic VSD; patch repair; left ventricle

Extracorporeal membrane oxygenation in a child with traumatic ventricular septal defect

Abstract Traumatic ventricular septal defect is an uncommon event following blunt thoracic trauma. Within the pediatric trauma literature, extracorporeal membrane oxygenation is most commonly used for secondary acute respiratory distress syndrome. We present the first account of rescue extracorporeal membrane oxygenation to allow for safe transport and access to definitive operative repair in the setting of blunt cardiac injury.

Traumatic Muscular Ventricular Septal Defect Following Non-Penetrating Chest Injury

Traumatic Muscular Ventricular Septal Defect Following Non-Penetrating Chest Injury

A case of 10 year follow-up after transcatheter closure of a traumatic ventricular septal defect.

Ventricular septal defect (VSD) is an uncommon complication of penetrating heart injuries, but transcatheter closure has emerged as a new technique and is widely used worldwide. In spite of high success rate and minimal operative mortality, short-term follow-up post-operation and long-term follow-up post-operation have not been observed. In the present study, we report a case of cardiac injury after stabbing himself with a dagger. The patient was diagnosed with a post-traumatic VSD with left-to-right shunt and was transferred to theatre where the defect was successfully repaired. Seven days later, on echocardiography examination, an occluder closing the defect with no residual leak was revealed. During the extensive follow-up over 10 years, no complication of occluder break, translocation and thrombosis formation occurred.

Emergency Closure of a Traumatic Ventricular Septal Defect (VSD) after a Horse Kick Injury with an 18-mm Occlutech ASD Occluder

Objective: Thoracic injuries after accidents with horses include chest lung contusions, rib fractures, and rarely cardiac involvement including right heart perforation, avulsion of the tricuspid or mitral valve and aortic dissections. We report a unique case of a traumatic ventricular septal defect.

Blunt cardiac injury without external evidence of thoracic trauma: A report of two pediatric cases

Objective: To report two cases of cardiac injury following blunt thoracic trauma without external evidence of injury. Design: Case report and review of the literature. Setting: A 23-bed pediatric intensive care unit in an academic children’s hospital. Interventions: Two children presented following significant thoracic trauma without external evidence of injury. Cardiac injury was not initially suspected, and lack of definitive diagnostic evaluation led to a delay in diagnosis and definitive treatment. Results: A 4-year-old girl presented 6 months after initial injury and evaluation with massive right ventricular dilatation secondary to traumatic tricuspid regurgitation. The second patient, an 11-year-old boy, underwent a laparotomy for suspected abdominal pathology delaying diagnosis of his traumatic ventricular septal defect and definitive repair until clinical hemodynamic deterioration occurred. Conclusion: Clinicians should maintain a high index of suspicion for cardiac injury in patients with a significant mechanism of thoracic trauma despite external evidence. Standard screening tests are often inadequate and echocardiography should be performed for any suspected cardiac trauma.

Ventricular septal defect from blunt cardiac injury: A case report and meta-analysis of 64 patients from 61 reviews

A 36-year-old male motorcyclist involved in a motor vehicle accident (MVA) with loss of consciousness and sustained multiple orthopedic injuries and a traumatic ventricular septal defect (VSD) which was hemodynamically stable. He then underwent emergency orthopedic surgery and was discharged after 5 weeks to rehabilitation. Subsequently, 6 months later, he underwent an elective repair of a 1.5 cm apical septal defect with uneventful recovery. A meta-analysis of 61 other reports of traumatic VSD revealed MVA as the most common etiology in 57.8%, predominantly males in 85.5% and younger age group <30 years in 87.5%. The midmuscular septum was involved in 43.6%, and patch closure was used in the majority of patients performed through a right or left ventriculotomy. Operative mortality was zero with elective versus 27.3% for emergency repairs, which also had a 27.3% VSD recurrence. 28.6% of the patients required concomitant cardiac surgical procedures while two patients (4.1%) both with perimembranous VSD required a permanent pacemaker. Less invasive transcatheter closure was successfully deployed in three patients without any complications, and it is an alternative in patients with a suitable anatomy and no associated cardiac injuries requiring surgery. Conservative therapy as a mainstay of treatment should be reserved for asymptomatic small defects with hemodynamically insignificant shunts.

Percutaneous Closure of a Traumatic Ventricular Septal Defect After Transcatheter Aortic Valve Implantation

An 89-year-old patient underwent successful transcatheter implantation of a 26-mm Edwards Sapien valve in the aortic position. Clinical improvement was initially observed, but after 6 months the patient's condition deteriorated, leading to a novel evaluation. A 6-mm acquired perimembranous ventricular septal defect (VSD) was diagnosed, with a significant shunt (Qp/Qs ratio = 2 at right heart catheterization) (A).

Coronary fistula with ventricular septal defect following chest trauma

We report on a 51-year-old male who developed traumatic ventricular septal defect and coronary artery fistula after an industrial accident involving injury to his chest. The defects were initially haemodynamically non-significant but he progressively developed symptoms of heart failure with associated dilatation of left atrium and ventricle. The ventricular septal defect was diagnosed by echocardiography and the coronary artery fistula was identified by pre-operative angiography. Both defects were surgically repaired more than one year after the injury. A large muscular ventricular septal defect was patched and the coronary artery fistula was closed from within the right ventricle.

Traumatic ventricular septal defect and flail tricuspid valve: Successful management by an extracorporeal membrane oxygenator–supported hybrid approach

We report the successful management of a critically ill patient with a traumatic ventricular septal defect (VSD) and flail tricuspid valve sustained in a motorcycle accident. Multiple orthopedic injuries prevented emergency cardiac surgery. The patient was stabilized by venous arterial extracorporeal membrane oxygenator support which allowed initial orthopedic repair. Repair of his cardiac injuries was then accomplished using a hybrid approach of percutaneous VSD closure using an Amplatzer post myocardial infarction VSD occluder which was also coil embolized followed by surgical tricuspid valve replacement.

Transcatheter closure of a traumatic ventricular septal defect using an amplatzer™ atrial septal occluder device

A relatively rare occurrence, the incidence of ventricular septal defect (VSD) complicating penetrating cardiac trauma has been reported at 4.5%. Closing such defects may be challenging especially in an unstable patient where cardiopulmonary bypass may exponentially increase the surgical risk. In such patients, catheter-based device closure is a reliable and effective alternative. We describe case of a 30 year old man who presented with a stab wound to his anterior mediastinum. His injuries involved laceration to right and left ventricles and a VSD. His lacerations were repaired on a beating heart and the VSD was not addressed due to patient hemodynamic instability. The VSD was semi-electively closed using a 24 mm Amplatzer™ device as the patient demonstrated significant left to right shunt. Post-device closure, the patient developed hemolysis attributed to an intra- device residual leak. The hemolysis resolved without any complications by conservative medical management. At latest follow-up the patient is in NYHA functional class I-II.

Which device should be chosen for the percutaneous closure of post-traumatic ventricular septal defects?

Dear Editor, We read with great interest the article “Percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder” written by Xi EP et al. (1). The authors aimed to report their experiences with three patients who underwent the percutaneous closure of a post-traumatic ventricular septal defect (VSD) with a patent ductus arteriosus (PDA) occluder. They concluded that the closure of a post-traumatic ventricular septal defect using a PDA occluder is feasible, safe, and effective. We believe that these findings will act as a guide for further studies regarding the closure of post-traumatic ventricular septal defects with occluder devices. We wish to make a minor criticism about this study. In the first case, the authors placed a muscular VSD occluder. However, its right plate had an inappropriate configuration; thus, they closed the defect with a PDA occluder. Therefore, they selected the PDA occluder in the two subsequent patients. Although the percutaneous closure of traumatic and postinfarction VSDs can be accomplished with septal occluder devices safely and effectively (2,3), why did they choose the PDA occluder for the other two patients? Additionally, why did they not try to implant a VSD occluder device? In the Discussion section, they indicated that the PDA occluder cannot cause a ventricular outflow tract obstruction. However, all of the patients had muscular VSD, which itself cannot occlude the outflow tract. The percutaneous therapy of structural heart defects has become an alternative approach to surgery in selected patients. The most important considerations before performing the percutaneous closure are whether the defect can be closed via the percutaneous approach and which device should be selected. There has generally been no consensus on the selection of the device. Further studies should be conducted in the development of defect-specific devices, which may result in an improvement in patient outcome.

Multi-Modality Imaging in a Hybrid Setting Facilitates Transcatheter Closure of a Traumatic Ventricular Septal Defect

We present a case of transcatheter closure of a traumatic ventricular septal defect (VSD), in which simultaneous 3-dimensional (3D) transesophageal echocardiography (TEE) and angiography played a critical role in defect sizing, device selection, and procedural guidance.

Ventricular Septal Avulsion and Ventricular Septal Defect After Blunt Trauma

Traumatic ventricular septal defect is an uncommon complication of blunt chest trauma. We report a case of ventricular septal avulsion, associated with traumatic ventricular septal defect and the associated management concerns.

Managing a traumatic ventricular septal defect with atrial septal defect occluder device

Traumatic ventricular septal defects are rare complications of blunt and penetrating chest trauma. Patients are usually referred because of shock or cardiac tamponade. Focusing on the critical condition of the patient leads to missing the presence of traumatic ventricular septal defects. In this case report, we introduce a patient with a large traumatic ventricular septal defect, which was diagnosed 40 days after a penetrating cardiac trauma and was finally treated with transcatheter closure.

Incidental Finding of Traumatic Ventricular Septal Defect on Transesophageal Echocardiography in the Intensive Care Unit

Incidental Finding of Traumatic Ventricular Septal Defect on Transesophageal Echocardiography in the Intensive Care Unit

Ventricular septal defect following blunt chest trauma

We present a 32-year-old male with ventricular septal defect (VSD) following blunt chest trauma. Traumatic VSD is a rare but potentially life-threatening injury, the severity, course and presentation of which are variable. While the diagnosis of myocardial injury may be challenging, cardiac troponins are useful as a screening and diagnostic test. The proposed pathophysiological mechanisms in the development of traumatic VSD are early mechanical rupture and delayed inflammatory rupture. We conducted a literature review to investigate the pathogenesis, distribution of patterns of presentation, and the associated prognoses in patients with VSD following blunt chest trauma. We found that traumatic VSDs diagnosed within 48 hours were more likely to be severe, require emergency surgery and were associated with a higher mortality. Children with traumatic VSDs had an increased mortality risk. Smaller lesions may be managed conservatively but should be followed up to detect late complications. In both groups elective repair was associated with a good outcome.

A large ventricular septal defect complicating resuscitation after blunt trauma

A young adult pedestrian was admitted to hospital after being hit by a car. On arrival to the Accident and Emergency Department, the patient was tachycardic, hypotensive, hypoxic, and acidotic with a Glasgow Coma Scale of 3. Despite initial interventions, the patient remained persistently hypotensive. An echocardiogram demonstrated a traumatic ventricular septal defect (VSD) with right ventricular strain and increased pulmonary artery pressure. Following a period of stabilization, open cardiothoracic surgery was performed and revealed an aneurysmal septum with a single large defect. This was repaired with a bovine patch, resulting in normalization of right ventricular function. This case provides a vivid depiction of a large VSD in a patient following blunt chest trauma with hemodynamic compromise. In all thoracic trauma patients, and particularly those poorly responsive to resuscitation, VSDs should be considered. Relevant investigations and management strategies are discussed.

Ventricular septal necrosis after blunt chest trauma

:Ventricular Septal Defect (VSD) after blunt chest trauma is a very rare traumatic affection. We report here a case of blunt chest injury-related VSD and pseudoaneurysm. A 30-year old male truck driver was referred from a trauma center to our hospital seven days after a blunt chest trauma and rib fracture. The patient had severe pulmonary edema and echocardiography showed large VSD. Several mechanisms are involved in the pathogenesis of this affection including an acute compression of the heart muscle between the sternum and the spine, leading to excessive changes in the intrathoracic and most likely the intracardiac pressure after blunt chest injury. Traumatical patients with the same symptoms may be at risk of sudden death. Therefore, a high grade of suspicion is mandatory even without solid evidence of myocardial damage on the initial evaluation. In continue some hidden angles of this case was discussed. Given the prognostic implications of traumatic VSD with associated pseudoaneurysm, its detection has critical value for preventing its clinical sequelae.

Stroke Complicating Traumatic Ventricular Septal Defect

BackgroundTraumatic ventricular septal defect (VSD) occurs in approximately 5% of blunt or penetrating cardiac injuries and can result in rare complications. ObjectivesTo report the serious complication of stroke after a traumatic VSD. Case reportA 27-year-old man with no previous medical history presented to the Emergency Department with aphasia and right hemiparesis after a stab wound to the chest. He underwent emergent evacuation of a pericardial effusion and repair of a right ventricular wall perforation. Head computed tomography revealed left middle cerebral artery infarct. Post-operatively, he was noted to have a cardiac murmur, and echocardiogram revealed a VSD. The VSD was surgically repaired without complication. ConclusionStroke can complicate traumatic VSDs.