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.

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.

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.

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.

Novel transcatheter closure of an iatrogenic perimembranous ventricular septal defect.

Iatrogenic membranous ventricular septal defects (VSD) are rare complications of cardiothoracic surgery, most commonly seen as a complication of aortic valve replacements. An iatrogenic VSD can lead to right sided heart failure, systemic hypoxia, and arrhythmias, and closure is often necessary. Given the increased mortality associated with repeat surgical procedures, percutaneous transcatheter closure of these iatrogenic VSDs has increasingly become the preferred choice of therapy. We describe the first case of iatrogenic membranous VSD in the setting of mitral valve replacement and tricuspid valve repair, using the newly approved Amplatzer Duct Occluder II Device from an entirely retrograde approach. © 2014 Wiley Periodicals, Inc.

Transcatheter closure of an iatrogenic ventricular septal defect after SAPIEN valve implantation.

A 57-year-old woman developed progressive calcific mitral and aortic valve disease with a porcelain aorta secondary to a history of radiation therapy. She was considered a very poor operative candidate and referred for transcatheter aortic valve replacement (TAVR). Four weeks after extensive coronary artery stenting, a TAVR was performed with a 23 mm Edwards SAPIEN valve (Edwards Life Sciences, Irvine, CA) through a transapical approach. Post-operatively, her symptoms of dyspnea persisted and worsened. She was found to have an acquired ventricular septal defect (VSD) measuring 8 mm by 5 mm by transesophageal echocardiogram and by a CT angiogram. Percutaneous VSD closure was accomplished with an 8 mm Muscular VSD Occluder (St. Jude Medical, St. Paul, MN) with elimination of her shunt, improvement of her dyspnea, and marked improvement in exercise tolerance.

Rare complication of ventricular septal defect in three patients following transcatheter aortic valve replacement.

Transcatheter aortic valve replacement (TAVR) is a highly-effective but technically challenging procedure. Despite improvement in device technology and operator techniques, complications are common and previously unknown procedural-related complications continue to arise. In this report, we present a case series of three patients with acquired perimembranous ventricular septal defects following transfemoral TAVR with an Edwards SAPIEN prosthesis.

Traumatic ventricular septal defect and flail tricuspid valve: successful management by an extracorporeal membrane oxygenator-supported hybrid approach.

We report the successful management of a critically ill patient with a traumatic ventricular septal defect (VSD) and flail tricuspid valve sustained in a motorcycle accident. Multiple orthopedic injuries prevented emergency cardiac surgery. The patient was stabilized by venous arterial extracorporeal membrane oxygenator support which allowed initial orthopedic repair. Repair of his cardiac injuries was then accomplished using a hybrid approach of percutaneous VSD closure using an Amplatzer post myocardial infarction VSD occluder which was also coil embolized followed by surgical tricuspid valve replacement.

Aortic valve regurgitation and ventricular septal defect diagnosed 5 years after penetrating cardiac injury.

Despite high mortality rates for penetrating heart injuries, developments in transport, diagnosis, and surgical interventions have increased survival rates. In some cases, life-threatening complications may be misdiagnosed or remain asymptomatic and lead to loss of life. Herein, we report a patient with aortic valve regurgitation because of noncoronary cusp perforation and ventricular septal defect that remained asymptomatic and diagnosed 5 years after a penetrating heart injury.

Transcatheter closure of a traumatic ventricular septal defect using an Amplatzer™ atrial septal occluder device.

A relatively rare occurrence, the incidence of ventricular septal defect (VSD) complicating penetrating cardiac trauma has been reported at 4.5%. Closing such defects may be challenging especially in an unstable patient where cardiopulmonary bypass may exponentially increase the surgical risk. In such patients, catheter-based device closure is a reliable and effective alternative. We describe case of a 30 year old man who presented with a stab wound to his anterior mediastinum. His injuries involved laceration to right and left ventricles and a VSD. His lacerations were repaired on a beating heart and the VSD was not addressed due to patient hemodynamic instability. The VSD was semi-electively closed using a 24 mm Amplatzer™ device as the patient demonstrated significant left to right shunt. Post-device closure, the patient developed hemolysis attributed to an intra- device residual leak. The hemolysis resolved without any complications by conservative medical management. At latest follow-up the patient is in NYHA functional class I-II.

Shot to the heart: a case of traumatic ventricular septal aneurysm and review of the literature.

Traumatic cardiac injuries are an uncommon diagnosis in the pediatric population. Of the traumatic cardiac injuries, more than 95% are contusions. Traumatic ventricular aneurysms are exceptionally rare, and most are detected during long-term follow-up. They are usually successfully managed medically but can require emergent surgical intervention. We report the case of a 6-year-old boy who was in a motor vehicle collision. He was found to have profound sinus bradycardia during initial resuscitation with hypotension. An electrocardiogram showed complete heart block. A cardiologist was consulted, and an echocardiogram was performed, which revealed a ventricular septal aneurysm. The case is followed by a review of the literature on traumatic cardiac injuries and ventricular septal aneurysms in the pediatric population.

[Cardiac perforation with a passive fixation lead penetrating ventricular septum; report of a case].

A 81-year-old female developed diaphragm twitching 2 days after the intravenous implantation of pacemaker (DDD mode) with passive fixation leads. A computed tomography (CT) and fluoroscopy revealed the lead perforating the interventricular septum and the ventricular wall without any sign of pericardial effusion. Surgical procedure through median sternotomy was performed, and the penetrated lead was removed. The injured myocardium was repaired with a U stitch reinforced by Teflon-feltstrips. New epicardial leads were fixed on the right atrial wall and on the inferior wall of the right ventricle. The patient had been doing well until 86-year-old, when she died of myelodysplastic syndrome.

Percutaneous device closure of congenital and iatrogenic ventricular septal defects in adult patients.

OBJECTIVES: We report our 10-year experience with percutaneous closure of adult congenital and acquired (non-post-infarct) ventricular septal defects (VSDs) using different types of Amplatzer occluder devices. BACKGROUND: Adult congenital and acquired VSDs may produce significant morbidity and mortality. Furthermore, such VSDs pose a significant surgical challenge. METHODS: Between February 2000 and August 2009, data were retrospectively reviewed from 28 patients who underwent 29 procedures for percutaneous device closure of hemodynamically significant VSDs. Seventeen had unrepaired congenital VSDs, 10 had post-operative VSDs (5 with residual patch-margin defects, 4 post-aortic valve replacement, 1 post-myomectomy), and one had an acquired traumatic VSD. INDICATIONS FOR CLOSURE INCLUDED: symptoms related to significant shunt (dyspnea on exertion); unexplained deterioration of LV function, and/or LV dilation; recurrent endocarditis, and pulmonary hypertension. Outcome parameters were procedural success, procedure-related complications, evidence of residual shunt by echocardiography, and improvement in the signs/symptoms for which the procedure was performed. The mean follow-up interval was 68 months. RESULTS: Of the 28 patients studied, a single VSD was present in 26 patients, while one patient had two defects, and one patient had one defect on the LV side with three openings at the RV side. The median size of the defects by echocardiography was 6 mm. A device was successfully implanted in 28 of 29 (97%) procedures and 28 of 28 (100%) patients. PROCEDURE-RELATED COMPLICATIONS OCCURRED IN TWO CASES: one involving an access site hematoma not requiring transfusion as well as nonsustained ventricular tachycardia that resolved spontaneously and the other involving acute mitral regurgitation due to inadvertent trapping of the anterior mitral valve leaflet between the left ventricular disk and the septum that was resolved by recapturing of the disk. There was immediate complete closure in 20 patients (71%). In six cases there was trivial residual shunt and in two patients the residual shunt was mild. At the latest follow-up, four of the eight with a residual shunt had no shunt and in the remaining four the residual shunt was trivial. Among symptomatic patients 18 (64%), there was marked improvement in symptoms and for those patients 17 (61%) for whom the procedure was performed to address left ventricular enlargement, there was reduction or stabilization in LV size on serial echoes. CONCLUSIONS: Percutaneous closure of VSDs in the adult patient appears to be safe and effective.

Successful repair of a traumatic ventricular septal defect using an amplatzer occluder guided by three-dimensional transesophageal echocardiography.

Transesophageal echocardiogram (TEE) guided perventricular cardiac intervention has gained popularity in recent years. We present a special case of perventricular closure conducted for a traumatic apical muscular ventricular septal defect (mVSD) under the guidance of three-dimensional (3D) TEE with an Amplatzer mVSD occluder and further discuss the important role of 3D TEE in perventricular cardiac intervention.

Transcatheter closure of a traumatic VSD in an adult requiring an ASD occluder device.

Traumatic ventricular septal defects (VSD) can occur after blunt or penetrating chest trauma or cardiac procedures. There are few publications reporting the safety and efficacy of transcatheter closure of traumatic VSDs. We report a case of a large VSD resulting from penetrating chest trauma that was not repaired at the initial surgical procedure on the disrupted right ventricle. Because of the late identification of the VSD postoperatively, transcatheter closure after the original surgical procedure was recommended and performed requiring an Amplatzer atrial septal defect occluder device because of defect size and configuration. This case describes the technique and postprocedure imaging leading to a cautionary note regarding VSD closure device techniques.

Transcatheter membranous ventricular septal defect closure through a mechanical aortic prosthesis using the Amplatzer membranous ventricular septal defect occluder.

An iatrogenic ventricular septal defect (VSD) after aortic valve replacement is rare, but represents a significant complication. Repeat surgery to repair such a defect carries a high surgical risk. The transcatheter approach (either transvascular or transapical) could be considered as an alternative to open chest surgery. We describe the successful transcatheter closure of an iatrogenic VSD with an Amplatzer membranous VSD occluder in a patient with previous combined mitral and aortic mechanical valve replacements. The device was implanted through a CarboMedics mechanical valve in the aortic position.

Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatum.

This paper presents four severe cardiac injuries that occurred in patients who underwent the minimally invasive repair of pectus excavatum (MIRPE). These complications occurred in different clinical settings, namely in a patient with an extremely severe form of pectus, in a patient who had previously undergone an open repair, after a previous open heart surgery, and at the time of bar removal. The purpose of this article is to review the circumstances leading to these cardiac injuries, share what we have learned from these patients, and hopefully help avoid these complications in the future.

Ventricular septal rupture in a 4-year-old child following blunt chest injury.

We report on a 4-year-old child who developed rupture of the ventricular septum after a blunt chest injury. The symptoms appeared more than 12 h later with progressive deterioration in his hemodynamic status. The diagnosis was made by echocardiography and the large defect in the muscular part of the ventricular septum was successfully closed at surgery.