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Percutaneous closure of a traumatic ventricular septal defect: a case report and literature review.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101469435 Publication Model: Electronic Cited Medium: Print ISSN: 1865-1372 (Print) Linking ISSN: 18651372 NLM ISO Abbreviation: Int J Emerg Med Subsets: PubMed not MEDLINE
    • Publication Information:
      Publication: [2018]- : [London, United Kingdom] : BioMed Central
      Original Publication: London : Springer, c2008-c2017.
    • Abstract:
      Background: Penetrating cardiac trauma is an entity with high pre and intrahospital mortality due to complications such as cardiac tamponade and massive hemothorax. A ventricular septal defect (VSD) occurs in 1-5% of cases and can present early or late. The management strategy for VSD resulting from penetrating cardiac trauma is uncertain.
      Case Presentation: A 19-year-old man was admitted in cardiorespiratory arrest after a precordial stab wound. Cardiopulmonary resuscitation was initiated achieving return of spontaneous circulation. eFAST evaluation revealed cardiac tamponade, he was taken to emergency left thoracotomy finding a perforation of the free wall of the left ventricle and a tear of the upper lobe of the left lung that were sutured. The patient was discharged and six days later was readmitted with fever and dyspnea. During treatment for a surgical site infection a new-onset pansystolic murmur was found: A transthoracic echocardiogram revealed a 13-mm VSD with left-to-right shunt. A multidisciplinary team recommended percutaneous closure of the defect which was successfully performed without complications.
      Conclusions: Traumatic VSD is a rare complication of penetrating cardiac trauma. A thorough clinical and echocardiographic evaluation is essential for its diagnosis and characterization. Symptomatic septal defects, those 10 mm or larger, with Qp: Qs greater than 1.5, or causing complications such as pulmonary hypertension or valvular involvement, are usually closed to prevent progression of heart failure. Management of traumatic VSD has traditionally been surgical. However, a percutaneous intervention is a viable alternative in selected stable patients. Unlike ischemic VSD, early intervention after patient stabilization generally yields favorable outcomes.
      Competing Interests: Declarations. Ethics approval and consent to participate: This case report was reviewed and approved by the Institutional Review Board (IRB) of Fundación Valle del Lili, Cali, Colombia. The patient provided informed consent for the use and publication of their medical information, and all identifying details have been anonymized to ensure confidentiality. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: The authors declare no competing interests.
      (© 2024. The Author(s).)
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    • Contributed Indexing:
      Keywords: Echocardiography; Emergency thoracotomy; Penetrating cardiac trauma; Percutaneous closure; Ventricular septal defect
    • Publication Date:
      Date Created: 20250109 Latest Revision: 20250112
    • Publication Date:
      20250112
    • Accession Number:
      PMC11715082
    • Accession Number:
      10.1186/s12245-024-00805-z
    • Accession Number:
      39789430