Ventricular septal necrosis after blunt chest trauma

Abstract

Abstract: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.

Blunt cardiac trauma: a narrative review

“…Atrial injuries are often at the venous-atrial confluence with injuries at the junctions of the inferior vena cava (IVC) and RA, and pulmonary veins and LA being relatively common. Atrial injuries are also more common when the atrioventricular valves are closed in late systole, while injuries occurring in end-diastole as maximal filling of the ventricles is more likely to result in ventricular rupture ( 1 , 2 , 4 , 6 - 9 , 20 , 23 , 27 , 30 , 34 , 41 , 46 - 51 ).…”

“…A traumatic VSD can form in both the membranous and muscular portions of the septum. With a free wall rupture, if the ruptured myocardium is sealed off by the pericardium and thrombus, a pseudoaneurysm can develop, which itself has a high risk of rupture ( 1 , 27 , 30 ).…”

“…They have also been utilized in the evaluation of cardiac trauma as both can be increased as a result of injury to the heart. CK is often released from skeletal muscle as well and so is less specific for cardiac damage, especially in the context of multi-system trauma as is often seen with BCT ( 3 , 8 , 18 , 21 , 30 ).…”

“…Initially, ECG should be performed in order to assess for arrhythmias, MI, or other cardiac injuries. Cardiac enzymes may be used, and monitored regularly for the first 24–48 hours, to evaluate cardiac injury ( 2 , 3 , 30 , 48 ).…”

“…Free wall rupture and septal defects are visible on CT, although CT may not be appropriate in acutely unstable patients such as many of those with free wall rupture and traumatic septal defects. A more invasive option is the pericardial window which can be utilized to directly visualize the pericardium and heart to evaluate for rupture or bleeding ( 3 , 7 , 23 , 30 , 38 , 41 , 47 , 48 , 50 , 52 ).…”