Traumatic Ventricular Septal Defect Research Articles

Ventricular Septal Defect as a Result of Direct Trauma From Mechanical Mitral Valve Prosthesis

We present a case of a patient with preexisting mechanical mitral valve who developed a traumatic ventricular septal defect following a motor vehicle accident. Serial transthoracic echocardiography revealed the progressive nature of the defect. Surgical repair was delayed due to significant noncardiac comorbidities. The ventricular septal defect was found in an unusual location in the membranous portion of the interventricular septum. We discuss the possible etiologic mechanisms of injury as well as the importance of timely surgical repair.

Traumatic Ventricular Septal Defect

Traumatic ventricular septal defect (VSD) is an uncommon occurrence in cases of penetrating cardiac injury with an incidence of only 1% to 5%. The mainstay of diagnosis of VSDs is the transthoracic echocardiogram. We report a case of an occult traumatic VSD, which was not seen on echocardiography, but was later found on a high-resolution computed tomographic scan of the chest.

Traumatic ventricular septal defect in a 4-year-old boy after blunt chest injury

Traumatic ventricular septal defect (VSD) resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury.

Traumatic Ventricular Septal Defect and Tricuspid Regurgitation

TRAUMATIC VENTRICULAR SEPTAL DEFECT AND TRICUSPID REGURGITATION Joseph Shiber, MD,* and Marcelo Cardarelli, MD† *Department of Surgical Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, and †Director of Pediatric Cardiac Surgery, University of Maryland, Baltimore, Maryland Reprint Address: Joseph Shiber, MD, Medical Intensivist, The Methodist Hospital, 6565 Fannin St., Houston, TX 77030

Successful Repair of a Traumatic Ventricular Septal Defect Using an Amplatzer Occluder Guided By Three-Dimensional Transesophageal Echocardiography

Transesophageal echocardiogram (TEE) guided perventricular cardiac intervention has gained popularity in recent years. We present a special case of perventricular closure conducted for a traumatic apical muscular ventricular septal defect (mVSD) under the guidance of three-dimensional (3D) TEE with an Amplatzer mVSD occluder and further discuss the important role of 3D TEE in perventricular cardiac intervention.

Transcatheter closure of a traumatic ventricular septal defect

Transcatheter closure of a traumatic ventricular septal defect

Delayed Diagnosis of Traumatic Ventricular Septal Defect in Penetrating Chest Injury: Small Evidence on Echocardiography Makes Big Difference

Cardiac trauma from penetrating chest injury is a life-threatening condition. It was reported that < 10% of patients arrives at the emergency department alive. Penetrating chest injury can cause serious damage in more than 1 cardiac structure, including myocardial lacerations, ventricular septal defect (VSD), fistula between aorta and right cardiac chamber and valves. The presence of pericardial effusion (even a small amount) on the initial echocardiography might be the only clue to serious cardiac damage in the absence of definite evidence of anatomical defect in heart. We here present a case, in which clear diagnosis of VSD and pseudoaneurysmal formation was delayed a few days after penetrating chest injury due to the lack of anatomical evidence of damage.

Traumatic ventricular septal defect following a stab wound to the chest

A 51-year-old man who had been suffering from depression stabbed himself in the chest with an ice pick. At presentation, an ice pick lodged in the left fifth intercostal space was moving synchronously with his heartbeat. Echocardiography revealed that the tip was penetrating the anterior wall of the right ventricle. Because the patient was tamponading, an emergency operation was carried out. The ice pick was removed following the establishment of a cardiopulmonary bypass and pericardiotomy. The perforation of the right ventricle was closed with a pledget-reinforced mattress stitch. On postoperative day 12, a holosystolic murmur was detected on auscultation. Transthoracic echocardiography revealed a ventricular septal defect 5 mm in diameter located near the apex. The pulmonary-tosystemic flow ratio was 1.1 by echocardiographic measurement. No sign of heart failure was present. Although it was agreed to manage the ventricular septal defect conservatively, careful echocardiographic follow-up is mandatory.

Percutaneous closure of a complex posttraumatic muscular ventricular septal defect

We report the percutaneous closure of a complex traumatic ventricular septal defect resulting from a stab wound to the anterior chest. The patient presented with heart failure 3 months after the initial trauma. Evaluation revealed a new large ventricular septal defect with diminished cardiac function. Closure was accomplished with a combination of an Amplatzer muscular ventricular septal defect occluder and two Amplatzer vascular plugs.

Delayed Pericardial Tamponade, Mitral Insufficiency and VSD after Stab Wound to the Heart

We report a case of delayed pericardial tamponade and presentation of a mitral insufficiency and traumatic ventricular septal defect (VSD) after a cardiac stab wound in an attempted suicide. Delayed tamponade in combination with a VSD and mitral valve injury is a rare complication after a stab wound to the heart. Normal echocardiographic findings, no murmur at admission and relatively benign clinical conditions may be misleading after cardiac trauma. The presented case links the rapid deterioration of the clinical condition and the development of a pericardial effusion to a Valsalva maneuver.

Dilated cardiomyopathy and functional mitral regurgitation complicated with traumatic ventricular septal defect

He was medically treated because the left-to-right shunt was relatively small, with a 1.39 pulmonary/systemic flow ratio (Qp/ Qs). His clinical condition remained satisfactory until the age of 59 years, when he started to complain of dyspnea on exertion. Transthoracic echocardiographic analysis revealed a dilated left ventricle with diffuse hypokinetic wall, severe MR, and the VSD (Figure 1). The left ventricular ejection fraction was 30.5%. The left ventricular end-diastolic, left ventricular end-systolic, and left atrial diameters were 68.5, 58.3, and 45.4 mm, respectively. Although he was taking medication with diuretics and digoxin, he repeatedly had heart failure and had the worst symptom at the age of 66 years. The Qp/Qs was 1.10, and there was no coronary artery disease on repeat cardiac catheterization. He underwent surgical intervention after 7 months of rigorous medical control of the heart failure. The New York Heart Association functional class had improved from IV to II before the operation. Intracardiac LVR of papillary muscle sling, concomitant mitral annuloplasty (MAP) and tricuspid annuloplasty, and patch closure of the VSD was performed (Figure 2). T h e left ventricle was opened from the apex to the middle part, with an incision parallel to the left anterior descending artery. There was a scar lesion over the ventricular septum, at the center of which was 5-mm VSD. There were no scar lesions in any other part of the myocardium. The abnormal displacement of the papillary muscles was corrected with a 5-mm Gore-Tex tube (WL Gore, Flagstaff, Ariz) encircling the base of the papillary muscles, which banded them side-by-side. There were no mitral leaflet abnormalities. The mitral valve repair was completed by means of MAP with an undersized annuloplasty ring (26-mm Physio-ring; Edwards

Transcatheter closure of a residual shunt after surgical repair of traumatic ventricular septal defect

We report a patient with a significant residual left-to-right shunt who underwent surgical repair for traumatic VSD. This 13-year-old boy was stabbed with a pair of scissors through his heart. After initial life-saving surgery with lacerated left ventricular wall repair and VSD closure, residual VSD was noted. Six months later, we performed a successful transcatheter closure of the residual VSD with an Amplatzer muscular VSD occluder.

Percutaneous closure of ventricular septal defects. State of the art

Ventricular septal defect (VSD) is the most common congenital heart disease. Surgery has been performed for many years and is considered to be the gold standard for the treatment of VSD. However, it is associated with morbidity and mortality. Percutaneous closure of VSDs is performed under general anesthesia and with fluoroscopic and transesophageal echocardiographic guidance. Two devices of the Amplatzer family are currently used to close percutaneously muscular and perimembranous VSD with a closure rate of 97% (incidence of major complication 2.2%) and 97.5% (major acute complications in 1.2%), respectively. Occurrence of complete atrioventricular block is reported in 1% of subjects. Acquired VSD can occur as post-surgical residual leak, as a traumatic event or as consequence of a myocardial infarction. There are few data about percutaneous closure of post-surgical residual VSD and of traumatic VSD. As for the surgical approach, in patients with post-myocardial infarction VSD success rate of percutaneous closure is around 88% with a mortality of 22%. The currently available data show that, in experienced hands, percutaneous closure is a safe and effective procedure. Device closure of muscular and perimembranous VSD is a real alternative to the standard surgical approach with the advantage of a significantly reduced rate of mortality and complications.

Magnetic Resonance Imaging of a Posttraumatic Myocardial Infarction and Ventricular Septal Defect With a Closure Device in Place

A 16-year-old boy sustained blunt trauma as a passenger in a high-speed motor vehicle accident 2 years earlier. Before the accident, he was healthy with no known cardiac disease or murmur. On admission after the accident, he was noted to have a loud IV/VI holosystolic murmur along the left sternal border. One month after admission, an echocardiogram revealed a 1.5-cm muscular ventricular septal defect with a left-to-right shunt, enlargement of the right atrium and ventricle, elevated pulmonary arterial pressure, and moderate tricuspid regurgitation (Figure 1 and Movie I). Figure 1. Delayed contrast enhancement in the short-axis plane demonstrates both sides of the …

Transcatheter closure of a ventricular septal defect resulting from knife stabbing using the Amplatzer muscular VSD occluder

We report for the first time the transcatheter closure of a traumatic ventricular septal defect (VSD) with the Amplatzer muscular VSD occluder in a 34-year-old man who had been stabbed through the heart. After his initial life-saving surgery to relieve tamponade, control bleeding, and repair the lacerated right ventricle, the risks and difficulties of subsequent open heart surgery were felt to favor transcatheter closure. We review other reports of transcatheter closure of traumatic VSD.

Ventricular Septal Rupture After a Nonpenetrating Chest Trauma

A 19-year-old man with no medical history was involved in a motorcycle accident with chest trauma and rapid deceleration. No injury was apparent initially, but 3 weeks later, he developed dyspnea and was referred to our echocardiography unit for assessment of a new 4/6 systolic heart murmur. 2D echocardiography (Figure 1) and cardiac magnetic resonance (CMR) …

Traumatic Ventricular Septal Defect: Case Report and Review of the English Literature since 1970

Traumatic Ventricular Septal Defect: Case Report and Review of the English Literature since 1970

Repair of traumatic ventricular septal defect following blunt chest trauma by septal obliteration technique

Repair of traumatic ventricular septal defect following blunt chest trauma by septal obliteration technique

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

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

Transcatheter Closure of Traumatic Ventricular Septal Defect : An Alternative to Surgery

The incidence of ventricular septal defect (VSD) occurs in up to 4.5% of penetrating cardiac trauma. We report a patient with persistent VSD who underwent surgical repair with significant left-to-right shunt and signs of heart failure. We performed a successful transcatheter closure of the VSD with an Amplatzer septal occluder (AGA Medical Corporation; Golden Valley, MN).