Missed Traumatic Conoventricular Septal Defect: A Case Report.

Traumatic ventricular septal defects (VSDs) after penetrating trauma to the left chest are rare. Most of the traumatic VSDs are located in the muscular ventricular septum, and a few reports place them in the membranous ventricular septum. There has been no report of traumatic conoventricular VSD by penetrating trauma. We present a case of penetrating cardiac injury (PCI). The rupture of the right ventricular free wall was found and repaired in emergency operation. This is the first report of the use of auricular forceps to control cardiac rupture bleeding. After operation, we found traumatic conoventricular VSD, which was repaired under cardiopulmonary bypass.

Intracardiac shunts following transcatheter aortic valve implantation: a multicentre study.

AIMS: The aim of this study was to describe the incidence, mechanisms, management and outcomes of intracardiac shunts (ICS) following TAVI. METHODS AND RESULTS: This was a multicentre registry across 10 centres aimed at gathering all cases of ICS (1.1%) including infection-related (IRICS, 0.3%) or aseptic (AICS, 0.8%) shunts. Patients presented porcelain aorta (24% vs. 6.8%, p=0.024) and had been treated with predilation (88% vs. 68.5%, p=0.037) or post-dilation (59.1% vs. 19.3%, p<0.001) more often. Median time from intervention to diagnosis of ICS was 10 days (IQR: 2-108), being longer for IRICS (171 [63-249] vs. 3 [1-12] days, p=0.002). Interventricular septum (55.6%) and anterior mitral leaflet (57.2%) were the most common locations for AICS and IRICS, respectively. Most patients (76%) developed heart failure but 64% were medically managed. Seven patients (38.9%) underwent percutaneous closure of AICS. The in-hospital mortality rate was 44% (IRICS 100%, AICS 27.8%) compared to global TAVI recipients (8.1%, p<0.001). At one-year follow-up, 76% of the patients had died. ICS, logistic EuroSCORE, and moderate-severe residual aortic regurgitation were independent predictors of death. CONCLUSIONS: Post-TAVI ICS are an uncommon complication independently associated with high early mortality. Currently, most therapeutic alternatives yield poor results but percutaneous closure of AICS was feasible and is a promising alternative.

Interventricular Septal Pseudoaneurysm After Blunt Chest Trauma in a 6 Year Old: An Illustrative Case and Review.

Motor vehicle accident is the most common cause of blunt cardiac injury (BCI) in children (85.3%) due to the height of the child in relation to proper restraints and the compliant pediatric rib cage (J Trauma. 1996;40:200-202). Trauma to the chest wall may lead to injury of the myocardium, resulting in myocardial contusion, ventricular septal defect (VSD), ventricular free wall rupture, or valve compromise (J Trauma. 1996;40; 200-202; Heart Lung. 2012;41:200-202; J Inj Violence Res. 2012;4:98-100). There are several proposed mechanisms for the formation of VSD after blunt chest trauma including rupture of ischemic myocardium related to the initial trauma and reopening of a spontaneously closed congenital VSD. Also, chest trauma during isovolumetric contraction of the ventricles may generate enough intraventricular force to cause myocardial rupture (J Trauma. 1996;40:200-202; J Inj Violence Res. 2012;4:98-100; Korean J Pediatr. 2011;54:86-89; Ann Thorac Surg. 2012;94:1714-1716; J Emerg Trauma Shock. 2012;5:184-187). Previous case reports highlight the formation of a true VSD after BCI and the requirement of emergent repair (J Emerg Trauma Shock. 2012;5:184-187; Am Heart J. 1996;131:1039-1041; Korean Circ J. 2011;41:625-628; Ann Thorac Surg 2013;96:297-298; Kardiol Pol. 2013;71:992; Chin Med J. 2013;126:1592-1593). Reported is a case of a 6-year-old girl who developed an interventricular septal pseudoaneurysm after a motor vehicle accident of pedestrian versus car. On the day of presentation, she developed bradycardia after emergent surgical repair for abdominal trauma that required cardiopulmonary resuscitation including 5 minutes of chest compressions. At the time of resuscitation, an emergent transthoracic echocardiogram noted an interventricular pseudoaneurysm. She has been followed with serial transthoracic echocardiograms and has not required surgical intervention. We discuss the risk factors, prevalence, and diagnostic studies and recommended treatment options for structural heart disease after BCI.

Managing extensive mitral valve and ventricular septal injuries secondary to penetrating trauma.

Penetrating cardiac injuries with extensive intracardiac components and minimal epicardial components are a rare presentation. A 31-year-old male presented with complex mitral valve and ventricular septal injuries with partial atrioventricular disruption but with hardly visible epicardial injuries; the patient's presentation, progression of injuries and successful management are discussed.

Incremental value of live/real time three-dimensional transesophageal echocardiography in the assessment of ventricular septal rupture following acute myocardial infarction.

Ventricular septal rupture is a serious complication following acute myocardial infarctions and is associated with a significant mortality rate. Classically, two-dimensional transthoracic echocardiography has been used to diagnose this complication and visualize its location. Two-dimensional transesophageal echocardiography has supplemented the transthoracic approach by providing more accurate assessment of the defect size and in guiding closure both percutaneously and intraoperatively. This modality, however, is limited to two-dimensional views only, and a greater breadth of information is instead available through the use of three-dimensional transesophageal echocardiography. We present a series of 11 patients in which live/real time three-dimensional transesophageal echocardiography offered incremental benefits over two-dimensional imaging alone.

Traumatic Ventricular Septal Defect After Stab Wound to the Chest Missed by Transthoracic Echocardiography: A Case Report.

Traumatic ventral septal defect may be sustained after either blunt force or penetrating trauma to the chest. Severity ranges from asymptomatic to acute decompensated heart failure. Our patient suffered a stab wound to the chest and was initially taken to the operating room for repair of a lacerated right ventricle. Subsequent postoperative hemodynamic deterioration prompted a bedside transthoracic echocardiogram, which failed to identify causal factors. A transesophageal echocardiogram performed immediately after ventral septal defect was demonstrated. This case serves to highlight the gaps in current standard practice and encourages the use of transesophageal echocardiogram as a screening tool in patients after penetrating cardiac injuries.

Cardioembolic strokes resulting from a self-inflicted needle puncture involving both sides of the heart.

Foreign bodies in the heart are rare occurrences with a limited evidence base to guide recommendations on management. We report a case of multiple cardioembolic strokes as a result of a self-inflicted sewing needle puncture from the anterior chest through the right ventricle and interventricular septum with its tip in the left ventricle close to the subvalvular apparatus in a 39-year-old psychiatric patient. We discuss issues surrounding decision making and ongoing care and highlight the importance of further follow-up and reporting of cases to form a robust evidence base to guide future recommendations.

Transcatheter Closure of Iatrogenic VSDs after Aortic Valve Replacement Surgery: 2 Case Reports and a Literature Review.

We report 2 new cases of transcatheter closure of iatrogenic ventricular septal defects after aortic valve replacement surgery, together with our finding, in a literature review, of 9 additional patients who had undergone this procedure from 2004 through 2013. In all 11 cases, transcatheter device closure was indicated for a substantial intracardiac shunt with symptomatic heart failure, and such a device was successfully deployed across the iatrogenic ventricular septal defect, with clinical improvement. Our review suggests that transcatheter closure of iatrogenic ventricular septal defects in patients with previous aortic valve replacement surgery is a safe and effective treatment option, providing anatomic defect closure and relief of symptoms in the short-to-medium term.

Low-Velocity Nail-Gun Injuries to the Interventricular Septum: Report of Two Cases, One in a Child.

Nail-gun injury to the heart is rare. Nail-gun injury to the interventricular septum is rarer: we could find only 5 reported cases, and none involving a child. We report 2 additional cases, in which nails penetrated the interventricular septum without causing acute pericardial tamponade, heart block, or shunt across the septum. Transesophageal echocardiography provides a dynamic way to evaluate the patient preoperatively, intraoperatively, and postoperatively. In the cases reported here, both the adult with multiple interventricular nails and the child with a single nail underwent foreign-object removal via median sternotomy. The child needed cardiopulmonary bypass for removal of the nail. There were no short-term or long-term sequelae from these interventricular septal injuries.