Diagnosis and Management of Traumatic Ventricular Septal Defect

Traumatic ventricular septal defect following a stab wound to the chest

“…Some advocate that it should be reserved for cases with injury to the proximal coronary arteries or those with intractable heart failure as systemic heparinization can cause further bleeding owing to concomitant injuries to other organs or because most superfi cial injuries can be repaired without the aid of CPB. 4,9 In our case, CPB was established for the following reasons: First, there was little possibility that the patient had incurred concomitant injuries to the lungs or intraabdominal organs. Second, there was a chance that an injury could have occurred to the coronary artery.…”

“…5,9 This may be attributable to fi brotic healing and retraction of the intracardiac wound after the resolution of acute tissue edema. 5 In our case, bright red blood having spurted from the right ventricle should have given us reason to suspect the presence of a left-to-right shunt.…”

“…However, even if a VSD is detected intraoperatively, immediate repair is generally not recommended unless intractable heart failure develops. 4,9 Repair should be performed electively as spontaneous closure of traumatic VSD has been reported, 10 and not all VSDs need to be treated surgically. Furthermore, there is a risk of developing an infection when performing emergency open-heart surgery in an operative fi eld contaminated by a wounding agent.…”

“…The indication for elective surgical repair is a pulmonary-to-systemic fl ow ratio >2.0 (or sometimes >1.5) in parallel with congenital surgery or signifi cant right-heart overloading. 4,9 Elective repair may also allow time for the margins of the defect to fi brose, thus becoming more favorable to suturing. 9 In our case, the VSD is still patent 6 months after the operation (10 mm in diameter, pulmonary-to-systemic fl ow ratio 1.58), with no signs of right-heart volume overload or heart failure.…”

“…4,9 Elective repair may also allow time for the margins of the defect to fi brose, thus becoming more favorable to suturing. 9 In our case, the VSD is still patent 6 months after the operation (10 mm in diameter, pulmonary-to-systemic fl ow ratio 1.58), with no signs of right-heart volume overload or heart failure. Careful echocardiographic follow-up must be continued, however, as the size of the VSD as well as the amount of left-to-right shunt may increase with time.…”