Ventricular Septal Defect and Mitral Regurgitation Due to Penetrating Cardiac Trauma; a Case Report and Review of Literature
Archives of Academic Emergency Medicine,
Vol. 12 No. 1 (2024),
1 Dey 2024
,
Page e25
https://doi.org/10.22037/aaem.v12i1.2267
Abstract
Penetrating cardiac trauma is a fatal condition and can result in the injury of various parts of the heart. Ventricular Septal Defect (VSD) following these traumas occurs only in 1-5% of cases. The patients' conditions depend on location, size, and concomitant injuries. One of the uncommon coincidences with the VSD is Mitral Regurgitation (MR) due to injury to sub-valvular structures. In this study, we report a case of concomitant traumatic-induced VSD and MR in a 14-year-old boy following a stab wound to his chest. The patient was a teenage boy coming to the Rajaei Cardiology Hospital emergency room following a stab wound to the anterior and left part of his chest. Despite primary urgent surgery, his breathlessness had continued for three more months. Evaluations with Transthoracic Echocardiography (TTE) revealed VSD with concomitant MR, but there was no papillary muscle rupture. Cardiac Magnetic Resonance Imaging (MRI) and angiographic evaluation confirmed the provisional diagnosis. The Amplatzer VSD occluder repaired the VSD, and the patient was discharged following the resolution of his symptoms. Although the MR has been present in the follow-up echocardiography, the patient has been asymptomatic. Since the initial presenting symptoms and signs of VSD and MR might be subtle or delayed, imaging modalities such as TTE and Transesophageal Echocardiogram (TEE) are beneficial in determining the diagnosis and the optimal treatment.
- Ventricular Septal Defect
- Heart Injury
- Mitral Regurgitation
- Transthoracic Echocardiography
- Heart Surgical Procedure
How to Cite
References
Knowlin, L.T., J.P. McAteer, and TD. Kane, Cardiac injury following penetrating chest trauma: Delayed diagnosis and successful repair. Journal of Pediatric Surgery Case Reports, 2018. 39: p. 45-47.
Lustenberger, T., et al., Penetrating cardiac trauma in adolescents: a rare injury with excessive mortality. (1531-5037 (Electronic)).
Tang, A.L., et al., Postdischarge complications after penetrating cardiac injury: a survivable injury with a high postdischarge complication rate. Arch Surg, 2011. 146(9): p. 1061-6.
Topaloglu, S., et al., Penetrating trauma to the mitral valve and ventricular septum. (0730-2347 (Print)).
Rotman M Fau - Peter, R.H., et al., Traumatic ventricular septal defect secondary to nonpenetrating chest trauma. (0002-9343 (Print)).
Karagodin, I., et al., Stabbed Through The Heart: An Unusual VSD Presentation. (2666-0849 (Electronic)).
Scolan, V., et al., Rupture of the left ventricle due to blunt trauma–A pediatric case study and literature review. Journal of forensic and legal medicine, 2011. 18(5): p. 217-220.
Ryan, L., D.L. Skinner, and R.N. Rodseth, Ventricular septal defect following blunt chest trauma. Journal of Emergencies, Trauma, and Shock, 2012. 5(2): p. 184.
Skoularigis, J., P. Essop Mr Fau - Sareli, and P. Sareli, Usefulness of transesophageal echocardiography in the early diagnosis of penetrating stab wounds to the heart. (0002-9149 (Print)).
Wu, W.H., et al., Severe mitral regurgitation caused by perivalvular abnormal communication of the mitral valve due to blunt chest trauma. (1540-8175 (Electronic)).
Crompton, J.G., et al., Traumatic ventricular septal defect resulting in severe pulmonary hypertension. LID - rju107 [pii] LID - 10.1093/jscr/rju107 [doi]. (2042-8812 (Print)).
Paisley, M.J., Z. Deboard, and D. Thomas, High-Risk Repair of Traumatic Mitral Valve Rupture in the Setting of Polytrauma. (2194-7635 (Print)).
Rincón-Tello, F.M., et al., Mitral valve repair in severe mitral regurgitation after blunt chest trauma. (2352-6440 (Electronic)).
Kumar, A., et al., Management of Thoracic and Cardiac Trauma: A Case Series and Literature Review. Cureus, 2022. 14(6): p. e26465.
Mylonas, K.S., et al., Pediatric cardiac trauma in the United States: a systematic review. World Journal for Pediatric and Congenital Heart Surgery, 2018. 9(2): p. 214-223.
Kang, N., et al., Penetrating cardiac injury: overcoming the limits set by Nature. (1879-0267 (Electronic)).
Harling L Fau - Ashrafian, H., et al., Late surgical repair of a traumatic ventricular septal defect. (1749-8090 (Electronic)).
Seamon, M.J., et al., An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. (2163-0763 (Electronic)).
Xi, E.P., et al., Percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder. (1980-5322 (Electronic)).
Zhu, X., et al., Ventricular Septal Rupture After Blunt Chest Trauma in an Infant: A Case Report and Mini-Review. Frontiers in Pediatrics, 2020. 8.
Mortezaeian H , F.M., Vesal A, Alizadeh B, Khalili Y , et al, Mortezaeian H , Farshidgohar M, Vesal A, Alizadeh B, Khalili Y , et al. Long-Term Follow-up of Transcatheter Ventricular Septal Defect Closure in Children, and Comparison of Single-Hole Versus Multi-holes Ventricular Septal Defects. Iran J Pediatr. 2022;32(6):e129278. https://doi.org/10.5812/ijp-129278.
Kasem, M., et al., Transcatheter device closure of a traumatic ventricular septal defect. (0974-2069 (Print)).
Symbas, P.N., Residual or delayed lesions from penetrating cardiac wounds. (0012-3692 (Print)).
Jeon, K., et al., Delayed diagnosis of traumatic ventricular septal defect in penetrating chest injury: small evidence on echocardiography makes big difference. (2005-9655 (Electronic)).
Clancy, K., et al., Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. Journal of Trauma and Acute Care Surgery, 2012. 73(5): p. S301-S306.
Lam, J.Y., et al., Extracorporeal membrane oxygenation in a child with traumatic ventricular septal defect. Journal of Pediatric Surgery Case Reports, 2018. 28: p. 81-83.
Kim, Y.M., et al., Traumatic ventricular septal defect in a 4-year-old boy after blunt chest injury. Korean journal of pediatrics, 2011. 54(2): p. 86.
Cowley, C.G. and R.E. Shaddy, Transcatheter treatment of a large traumatic ventricular septal defect. Catheter Cardiovasc Interv, 2004. 61(1): p. 144-6.
Bridges, ND, et al., Preoperative transcatheter closure of congenital muscular ventricular septal defects. (0028-4793 (Print)).
Malakan Rad, E., PN Davari, and H. Mortezaeian, Embolization of immediate release transcatheter patch for atrial septal defect occlusion: the causes and the pitfalls to avoid. The journal of invasive cardiology, 2012. 24(3): p. E60-3.
Jiang, D., et al., Transcatheter Device Closure of Perimembranous and Intracristal Ventricular Septal Defects in Children: Medium- and Long-Term Results. J Am Heart Assoc, 2021. 10(11): p. e020417.
Masuoka, A., et al., A case of ventricular septal defect and mitral insufficiency after blunt trauma. Asian Cardiovascular and Thoracic Annals, 2014. 22(7): p. 846-848.
Huis In 't Veld, MA, CA Craft, and R.E. Hood, Blunt Cardiac Trauma Review. Cardiol Clin, 2018. 36(1): p. 183-191.
Menaker, J., et al., Traumatic atrial septal defect and papillary muscle rupture requiring mitral valve replacement after blunt injury. J Trauma, 2009. 67(5): p. 1126.
Embrey, R., Cardiac trauma. Thoracic surgery clinics, 2007. 17(1): p. 87-93.
Leite, L., L. Gonçalves, and D. Nuno Vieira, Cardiac injuries caused by trauma: Review and case reports. Journal of Forensic and Legal Medicine, 2017. 52: p. 30-34.
Pasquier, M., et al., Traumatic mitral valve injury after blunt chest trauma: a case report and review of the literature. (1529-8809 (Electronic)).
Lee, A., et al., Penetrating cardiac trauma. Surg Open Sci, 2023. 11: p. 45-55.
De Raet, J., et al., Penetrating pediatric cardiac trauma caused by fall on a pencil with normal echocardiography. Interactive CardioVascular and Thoracic Surgery, 2004. 3(4): p. 634-636.
Sola, J.E., et al., Pediatric penetrating cardiac injury from abuse: a case report. Pediatric Surgery International, 2008. 24(4): p. 495-497.
Elkbuli, A., et al., Successful management of gunshot wound to the chest resulting in multiple intra-abdominal and thoracic injuries in a pediatric trauma patient: A case report and literature review. Int J Surg Case Rep, 2020. 76: p. 372-376.
De Decker, R., et al., Uneventful survival of a rural child after penetrating cardiac injury by a thorn: a case report. Eur Heart J Case Rep, 2019. 3(3): p. ytz106.
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