Ventricular septal defect following blunt chest trauma

Abstract

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.

Traumatic ventricular septal rupture associated with rapid progression of heart failure despite low Qp/Qs ratio: a case report

“…It is possible that early mechanical rupture causes sudden hemodynamic overload, whereas delayed inflammatory rupture causes gradual hemodynamic changes, leading to more frequent decompensation in patients diagnosed in the early phase. Consistent with this notion, it was previously described that patients with traumatic VSR diagnosed within 48 h after injury were more likely to require emergent surgery and associated with a higher mortality compared with those diagnosed after 48 h of injury [7]. VSR was diagnosed approximately 12 h after injury in the present case, suggesting that VSR was caused by early mechanical rupture and resulted in rapid progression of circulatory failure despite relatively small Qp/Qs ratio.…”

Ventricular septal perforation after blunt chest trauma due to blows from a fist

“…Various mechanisms of onset in VSP by trauma have been reported . Bright and Beck analyzed 152 cases of blunt cardiac rupture diagnosed at necropsy .…”

“…Suturing of fragile or necrotic tissues during emergency surgery could possibly result in the recurrence of the VSP. However, large or symptomatic lesions should be surgically repaired . Patients with a VSP >1.5–2 cm or a Qp/Qs ratio >1.5–2, which can cause congestive cardiac failure that is difficult to treat by medication, should undergo surgical repair immediately .…”

Blunt Chest Trauma Resulting in Both Atrial and Ventricular Septal Defects

“…The ischemic dissolution type rupture occurs when the myocardium is damaged resulting in localized inflammation and ultimately necrosis and rupture. This probably involves the microvasculature in the septal nutrient vessels and there may be delayed onset from hours to weeks after trauma occurs. This mechanism is consistent with the clinical findings in our case.…”