Acquired ventricular septal defect: A rare sequel of blunt chest trauma in a 7-year-old boy

Abstract

Ventricular septal defect (VSD) is the most common congenital cardiac lesion encountered worldwide. Only very rarely is it acquired, and causation through blunt injury in a child is extremely rare. A previously healthy 7-year-old boy suffered blunt chest trauma while at play. He presented 11 days later with features of acute congestive cardiac failure. Two-dimensional echocardiographic examination revealed a mid-muscular VSD. The connection between the defect and the trauma was not initially appreciated. Facilities for required urgent open-heart surgery were not available. Cardiac failure was refractory to anti-failure therapy. His clinical condition steadily worsened, and he succumbed after 20 days on admission. We conclude that a diagnosis of traumatic VSD, though rare, should be considered in any previously well child presenting in acute congestive cardiac failure following blunt trauma to the chest. Any such patient should undergo careful echocardiographic evaluation. There is an urgent need for facilities for open-heart surgery to be more readily available and accessible in Nigeria.

Ventricular Septal Rupture After Blunt Chest Trauma in an Infant: A Case Report and Mini-Review

“…The case described herein is similar to the acquired VSR cases due to BCT previously reported in children (4)(5)(6)(7)10). Specifically, Ogunkunle et al reported BCT induced VSR in a 7-year-old child (4).…”

“…Acquired VSD is very rare, and is mainly due to trauma, myocardial infarction, or complications of cardiac surgery such as valve replacements or closure of VSD, endocarditis (2). Ventricular septal rupture (VSR), also called traumatic VSD, is a rare complication of blunt chest trauma (BCT) in children (3)(4)(5). The formation mechanism of VSD after BCT has been suggested as the ischemic myocardial rupture associated with initial trauma, and/or the reopening of spontaneously closed congenital VSD (6,7).…”

“…Non-invasive imaging of the intra-cardiac structure with high spatial and temporal resolutions can be obtained by echocardiography in children. Therefore, echocardiography is the modality of choice for the diagnosis and management of VSR (4,8). Bedside echocardiography is the most rapid and feasible modality to diagnose and follow-up acute and severe VSR cases.…”

Haemodialysis for paediatric acute kidney injury in a low resource setting: experience from a tertiary hospital in South West Nigeria

“…Malignancy was the cause of AKI in six patients, and was secondary to non-Hodgkin's lymphoma in five patients, including one patient with Burkitt lymphoma. One patient had AKI complicating acquired ventricular septal defect and heart failure, which followed blunt injury to the chest [ 24 ].…”

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

“…1,3 Other case reports of traumatic VSD had associated pulmonary contusions and has been shown to be a life threatening injury. 4,5 The presence of pulmonary contusion should alert the physician to the possibility of occult cardiac trauma.…”