Penetrating Trauma Resulting in Ventricular Septal Defect

Juneau, Daniel; Hermann, Daniel; Wells, Gretchen

doi:10.4236/wjcs.2014.45012

Cited by 3 publications

(13 citation statements)

References 11 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7 Cardiac tamponade provides an early opportunity for survival, and therefore, an urgent release of tamponade seems to be crucial. 7 Cardiac tamponade provides an early opportunity for survival, and therefore, an urgent release of tamponade seems to be crucial.…”

Section: Discussionmentioning

confidence: 99%

“…1 Table 1 shows that the time to reach a diagnosis of VSP ranges from 1 day to 10 years. 7 Conservative management is advocated in asymptomatic muscular VSPs, where in the absence of pulmonary hypertension, ventricular dimensions remain normal and Qp/Qs remains <2. 9 Predictors for death include exsanguination, left ventricular or intrapericardial great vessel injury, multiple-chamber injury, or a cardiac injury of 2 cm or more.…”

Section: Discussionmentioning

confidence: 99%

“…P ATIENTS SUSTAINING PENETRATING cardiac injury usually present with either cardiac tamponade or hemothorax and hypotension. 7 Cardiac tamponade provides an early opportunity for survival, and therefore, an urgent release of tamponade seems to be crucial. 2 We could recognize cardiac tamponade relatively easily; however, we could not detect VSP with echocardiography.…”

Section: Discussionmentioning

confidence: 99%

“…9 Predictors for death include exsanguination, left ventricular or intrapericardial great vessel injury, multiple-chamber injury, or a cardiac injury of 2 cm or more. 7 Conservative management is advocated in asymptomatic muscular VSPs, where in the absence of pulmonary hypertension, ventricular dimensions remain normal and Qp/Qs remains <2. To prevent congestive heart failure and pulmonary hypertension, VSPs should be repaired when the defect is large (Qp/ Qs ≥ 2.0).…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Delayed diagnosis of traumatic ventricular septal perforation in penetrating chest injury: hematoma formation in the ventricular septum in CT suggests perforation

Shioya

Inoue

Muto

et al. 2019

Acute Medicine & Surgery

View full text Add to dashboard Cite

Background Ventricular septal perforation (VSP) can be caused by a penetrating cardiac injury. Diagnosis of VSP tends to be delayed because a shunt might not be detected by color flow Doppler at an early stage following injury. Case presentation A 60‐year‐old man with depression was admitted to the emergency center after a knife injury in the chest. A focused assessment with sonography for trauma revealed cardiac tamponade. Shortly after an open cardiac massage and a pericardiotomy, his spontaneous circulation returned. At a later stage, follow‐up computed tomography, echocardiography, and left ventriculography showed traumatic ventricular septal perforation. Conservative therapy was chosen because the pulmonary blood flow/systemic blood flow ratio was 1.42. Conclusion The initial contrast computed tomography shows a septal hematoma. Its presence could be perceived as a perforation site in the interventricular septum.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Delayed diagnosis of traumatic ventricular septal perforation in penetrating chest injury: hematoma formation in the ventricular septum in CT suggests perforation

Shioya

Inoue

Muto

et al. 2019

Acute Medicine & Surgery

View full text Add to dashboard Cite

show abstract

“…Penetrating cardiac injuries are usually secondary to stab or gunshot wounds. They represent a life threatening condition that often requires emergency surgery for evacuation of the commonly associated cardiac tamponade [1][2][3][4][5][6] . The free ventricular walls, especially on the right side are more commonly affected [1,5] .…”

Section: Introductionmentioning

confidence: 99%

Ventricular septal defect and tricuspid and mitral valve insufficiency caused by penetrating trauma

López-Marco¹,

Williams²,

Tan³

et al. 2018

View full text Add to dashboard Cite

A 28-year old male sustaining a penetrating injury to the subxiphoid area presented to the emergency department fully conscious and haemodynamically stable. The CT scan revealed a localized infero-posterior pericardial collection. Emergency surgery was planned to evacuate the collection and assess the extent of injury. Intraoperative transoesophageal echocardiogram demonstrated severe tricuspid regurgitation due to transection of the papillary muscle, as well as a ventricular septal defect. Tricuspid repair with reconstruction of the papillary muscle, closure of the ventricular septal defect (VSD) and the right ventricular laceration was performed. Mitral regurgitation secondary to chordae rupture was identified following de-airing maneuvers, and subsequently underwent repair. Traumatic VSD and lesions of the mitral and tricuspid valves causing insufficiency have been reported before. They have been described in isolation or as combination of two lesions but never the combination of the three of them as described in this case.

show abstract

Late surgical repair of a traumatic ventricular septal defect

Harling

Ashrafian

Casula

et al. 2014

J Cardiothorac Surg

View full text Add to dashboard Cite

Ventricular Septal Defect (VSD) complicates approximately 1-5% of patients presenting with penetrating chest trauma, however not all VSDs are evident at the time of initial presentation to the emergency department. Acute closure of traumatic VSDs is indicated in patients with a large defect and haemodynamic compromise, however closure may be delayed in smaller defects in order to minimise operative time, reduce operative mortality and allow for recovery from the initial trauma. We describe the case of a previously healthy 23 year-old Caucasian man who presented in extremis following stab wounds to the precordium. After emergency cardiopulmonary bypass and closure of lacerations to both the left and right ventricles, postoperative trans-thoracic echocardiography (TTE) noted a restrictive intramuscular VSD with a high velocity left to right shunt, initially managed conservatively. Elective surgical closure was performed 10 months after the initial injury through a right ventriculotomy using 4–0 Proline sutures reinforced with Teflon pledgets. Despite excellent clinical recovery, 3-month follow-up TTE noted a residual VSD in the mid apical septum. However, given the presence of minimal left to right shunt and the small size of the defect, the patient was managed conservatively with annual review and repeat transthoracic echo. This case highlights the potential pitfalls in both the diagnosis and management of traumatic VSDs particularly where the patient presents in extremis with other life-threatening injuries. Furthermore, it exemplifies the importance of a multidisciplinary approach when planning any elective intervention. Regardless of the management strategy, repeated re-assessment and re-evaluation is vital following penetrating cardiac trauma, and vigilant long-term follow-up is of paramount importance in these cases.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0145-1) contains supplementary material, which is available to authorized users.

show abstract

Penetrating Trauma Resulting in Ventricular Septal Defect

Cited by 3 publications

References 11 publications

Delayed diagnosis of traumatic ventricular septal perforation in penetrating chest injury: hematoma formation in the ventricular septum in CT suggests perforation

Delayed diagnosis of traumatic ventricular septal perforation in penetrating chest injury: hematoma formation in the ventricular septum in CT suggests perforation

Ventricular septal defect and tricuspid and mitral valve insufficiency caused by penetrating trauma

Late surgical repair of a traumatic ventricular septal defect

Contact Info

Product

Resources

About