The multidisciplinary approach of a postraumatic ventricular septal defect: from clinical assesment to therapeutical management

Introduction: We are presenting the case of a 26 year old male, who was admitted for cardiovascular evaluation 2 weeks after the surgical treatment of a stabbed penetrating chest trauma, which caused hemorrhagic choc, superficial coma, haemopericardium, massive left haemothorax. The surgical exam showed a diaphragmatic centrotendinous wound, biventricular transfixiant trauma, haemopericard and left haemothorax, therefore the surgical therapy consisted in left and right ventricular suture, suture of the phrenic wound, pericar dial and pleural drainage. During the surgical procedure the patient had a cardio-respiratory arrest, which was responsive to the resuscitation maneuvers. Methods: The clinical exam revealed left parasternal systolic murmur, with irradiation on the entire precordial area. The echocardiography showed a posttraumatic ventricular septal defect localized in the apical region with an 8 mm diameter, with left -right shunt, maximum pressure gradient of 51 mm Hg and maximum velocity of 3.6 m/s. The thoracic CT exam confirmed the presence of the ventricular septal defect, localized in the inferior area of the septum, 13 mm from the cardiac apex, with left -right shunt, having an 8.5 mm diameter at the left ventricular and intraseptal level and 8 mm at the right ventricle level. The coronarography and ventriculography showed normal coronary arteries and moderate ventricular septal defect near the apex. Results: Due to the presence of a febrile syndrome, which responded to empirical antibiotherapy with Vancomicine 2g/day, associated with inflammatory syndrome and negative hemocultures, we decided to post pone the ventricular septal defect correction until the disappearance of the posttraumatic inflammatory syndrome, thus allowing an efficient post-surgery healing. The ventricular septal defect correction is to be done through interventional approach, by percutaneous implantation of an Amplatzer device. Conclusions: Unlike the congenital ventricular septal defects, the therapeutical management of a posttraumatic ventricular septal defect lacks an efficient standardization, due to the limited number of similar cases described in the medical literature. As the posttraumatic ventricular septal defects are rare and may sometimes close spontaneously, a “wait and see” approach seems to be the most suitable in a hemodinamically stable patient, thus taking into account both the clinical and paraclinical features that define the gravity of the shunt.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)