VSD following blunt cardiac trauma: MRI findings

Abstract

In this report, we describe the clinical and radiographic findings of ventricular septal defects (VSDs) following blunt cardiac trauma in two patients. VSDs following either penetrating or blunt cardiac trauma are a rare occurrence. The variable presentation and timing of symptom onset along with the common association of other injuries can make the diagnosis of a posttraumatic VSD difficult. Therefore, investigation should be initiated when elements from the history and physical examination (e.g., new onset murmur), laboratory tests (e.g., cardiac enzymes), EKG, and CT or echocardiography warrant it. The first patient was a 19-year-old male who was hemodynamically stable on initial presentation to this trauma center after a motor vehicle collision. A posttraumatic VSD was found by echocardiography on the day of admission and further defined on cardiac MRI (CMRI). The second patient was a 31-year-oid male who presented after a high-speed motorcycle accident and was found to have a VSD 40 days later on CMRI after a fluctuating clinical course and multiple normal echocardiograms. Both patients had good outcomes with subsequent surgical closure.

Blunt Chest Trauma Resulting in Both Atrial and Ventricular Septal Defects

“…Second, the characteristics of the forces applied to the heart in our case may have been unique since these combinations of injuries in nonfatal chest trauma have not been reported previously. Ventricular septal defects following nonpenetrating chest trauma can occur either acutely from direct mechanical injury or delayed from a microvascular disruption causing liquefaction necrosis and ischemic dissolution of septal tissue followed by a true defect . The mechanical injury may involve a sudden increase in intracardiac pressure caused by compression of the heart between the vertebral bodies and the sternum.…”

“…Ventricular septal defects following nonpenetrating chest trauma can occur either acutely from direct mechanical injury or delayed from a microvascular disruption causing liquefaction necrosis and ischemic dissolution of septal tissue followed by a true defect. 5 The mechanical injury may involve a sudden increase in intracardiac pressure caused by compression of the heart between the vertebral bodies and the sternum. If the trauma occurs during late diastole or isovolumetric systole when the heart has maximum volume and the valves are closed, the compression can result in an increase in intracardiac pressure above the threshold of cardiac septal wall integrity and rupture can occur acutely.…”