August 2023 Issue
ISSN 2689-291X
ISSN 2689-291X
Traumatic VSD: A Stab Wound Sequel!
Description
The 2-D apical 4-chamber transthoracic echocardiography (TTE) image with superimposed color-flow Doppler (A) and continuous wave spectral Doppler (B) reveals left-to-right shunting across the mid ventricular septum consistent with a ventricular septal defect (VSD). This was the result of a stab wound to the chest and was surgically patched without complications.
Discussion
Traumatic VSDs have been reported rarely in the setting of blunt trauma [1], but more commonly due to penetrating trauma [2]. Diagnosis can be challenging and may be missed by TTE [3], requiring a high index of suspicious and alternative diagnostic modalities. Isolated VSDs due to penetrating trauma may be amenable to device closure, mitigating the risk of open heart surgery [4]. Delayed surgical repair has also been reported, to allow healing from the original trauma [5]. Post repair follow up with TTE surveillance is essential to assess for pulmonary hypertension and assure continued patency of repair and absence of dehiscence around the repair site [6].
References
Rajasekhar Mulyala, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Nupur Shah, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Mustafeez Ur Rahman, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Mariam Riad, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Christopher Malozzi, D.O.
Associate Professor of Cardiology
University of South Alabama
Mobile, AL
Bassam Omar, M.D., Ph.D.
Professor of Cardiology
University of South Alabama
Mobile, AL
The 2-D apical 4-chamber transthoracic echocardiography (TTE) image with superimposed color-flow Doppler (A) and continuous wave spectral Doppler (B) reveals left-to-right shunting across the mid ventricular septum consistent with a ventricular septal defect (VSD). This was the result of a stab wound to the chest and was surgically patched without complications.
Discussion
Traumatic VSDs have been reported rarely in the setting of blunt trauma [1], but more commonly due to penetrating trauma [2]. Diagnosis can be challenging and may be missed by TTE [3], requiring a high index of suspicious and alternative diagnostic modalities. Isolated VSDs due to penetrating trauma may be amenable to device closure, mitigating the risk of open heart surgery [4]. Delayed surgical repair has also been reported, to allow healing from the original trauma [5]. Post repair follow up with TTE surveillance is essential to assess for pulmonary hypertension and assure continued patency of repair and absence of dehiscence around the repair site [6].
References
- Reinhardt SW, Popescu WM, Crandall I, Tantawy H, McNamara RL. Large Traumatic Ventricular Septal Defect. Circ Cardiovasc Imaging. 2019 May;12(5):e008783.
- Asfaw I, Thoms NW, Arbulu A. Interventricular septal defects from penetrating injuries of the heart: a report of 12 cases and review of the literature. J Thorac Cardiovasc Surg. 1975 Mar;69(3):450-7.
- Faloye AO, Gershon RY. Traumatic Ventricular Septal Defect After Stab Wound to the Chest Missed by Transthoracic Echocardiography: A Case Report. A A Case Rep. 2017 Aug 1;9(3):65-68.
- Khajali Z, Firouzi A, Jorfi F, Keshavarz Hedayati M. Device closure of a traumatic VSD in a young man with a history of a stab wound to the chest. J Cardiol Cases. 2020 Mar 31;21(6):217-219.
- Harling L, Ashrafian H, Casula RP, Athanasiou T. Late surgical repair of a traumatic ventricular septal defect. J Cardiothorac Surg. 2014 Sep 20;9:145.
- Lindenbaum G, Larrieu AJ, Goldberg SE, Wolk LA, Ghosh SC, Ablaza SG, Fernandez J. Diagnosis and management of traumatic ventricular septal defect. J Trauma. 1987 Nov;27(11):1289-93.
Rajasekhar Mulyala, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Nupur Shah, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Mustafeez Ur Rahman, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Mariam Riad, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Christopher Malozzi, D.O.
Associate Professor of Cardiology
University of South Alabama
Mobile, AL
Bassam Omar, M.D., Ph.D.
Professor of Cardiology
University of South Alabama
Mobile, AL