Clinical vignettes
Post-traumatic ventricular septal defect
Michal Šmíd*, Jirí Ferda2, and Viktor Zlocha1 on behalf of Charles University Prague Research Project MSM nr. 0021620817 Investigators
1Department of Cardiac Surgery, University Hospital Pilsen, alej Svobody 80, 304 60 Pilsen, Czech Republic
2Department of Radiodiagnostics, University Hospital Pilsen, Pilsen, Czech Republic
* Corresponding author. Tel: +42 0377104134, Email: kosvin@seznam.cz
A 20-year-old male was admitted to the emergency department with a stab wound in his chest in the cardiac region. Given the haemodynamic instability and suspected cardiac tamponade, urgent thoracotomy was performed with drainage of haemopericardium and cardiac surgery was performed immediately, during which right ventricular free wall laceration was sutured under extracorporeal circulation (Panel A). Before discharge, the patient underwent routine transthoracic echocardiography that revealed defect in the distal third of the interventricular septum, with sharply demarcated edges, 4–5 mm wide, and left to right shunt flow (Panel B). These findings were confirmed by magnetic resonance imaging (MRI) (Panel C and D). Given the asymptomatic course of the patient and size of the shunt, which has been assessed as non-significant (
Panel A. Suture of right ventricular free wall.
Panel B. Transthoracic echocardiography. Apical four-chamber view. Left to right shunt in the distal third of the interventricular septum (white arrow).
Panel C. Magnetic resonance imaging in the short axis showing the ventricular septal defect (white arrow).
Panel D. Magnetic resonance imaging in the long axis showing the ventricular septal defect with shunt flow (white arrow).
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