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

Abstract

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.

Penetration cardiac wound associated with anterior mitral leaflet perforation: a case report and review of the literature

“…Хирургическое вмешательство необходимо в случае гемодинамически значимых повреждений. Наиболее часто вмешательство проводится по поводу дефектов мышечной части МЖП как традиционным открытым хирургическим способом с доступом к входному и выходному отверстиям раневого канала через различные камеры сердца или магистральные сосуды в условиях искусственного кровообращения [6,10,17,36,48,[50][51][52][53][54][55][56][57][58], так и посредством чрескожной транскатетерной имплантации современных окклюдеров [33,45,[59][60][61][62][63].…”

The Role of Heart Team Approach in Penetrating Cardiac Trauma: Case Report and Review of the Literature

“…Afterwards, only three cases by Berry et al. [ 13 ] and Ali et al [ 17 ] , with good results (low postoperative recovery, total cardiac function restore without any interventricular septum shunt) were published. The use of minimally surgery (opening, controlling and treating the cause of bleeding) associated with the percutaneous occluder device implantation in penetrating cardiac injuries with iatrogenic VSD may be a complete and safe approach to this trauma patient.…”

Severe Mechanical Hemolysis After Transcatheter Closure of a Traumatic Ventricular Septal Defect Using the Amplatzer Atrial Septal Occluder

“…5) A review of the literature shows that a few cases of traumatic VSD have thus far been managed with an ASO device. 4,[6][7][8][9] In our patient, we decided to use an ASO device because the initial 18 mm AmVSDO easily prolapsed through the defect and due to the unavailability of a larger AmVSDO. Our case showed that transcatheter closure with ASO appears to be an option for patients with a large post-traumatic muscular VSD and significant hemodynamic compromise.…”

“…In their report, they advise against using an ASO device for traumatic VSD closure. Ali, et al 7) recently also utilized a 24 mm ASO device to close a traumatic VSD and they also reported hemolysis as a complication that was resolved by conservative medical management. However, our case demonstrated intractable hemolysis that was managed with surgical device removal.…”