Deutsche medizinische Wochenschrift (1946) · 1996
[Ventricular septal rupture after blunt chest trauma].
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Roithinger F X, Punzengruber C, Pachinger O
Аннотация
HISTORY AND CLINICAL FINDINGS: Case 1: a 20-year-old previously healthy man sustained multiple nonvascular injuries without visible chest trauma in a car accident. Four days later a loud systolic murmur was heard over the heart. Case 2: a 21-year-old man similarly sustained in a car accident multiple injuries without visible chest involvement but causing haemorrhagic shock. A loud systolic heart murmur was heard and after shock treatment he developed left heart failure requiring catecholamine infusions.
INVESTIGATIONS: Echocardiography demonstrated posttraumatic ventricular septal rupture in both patients. Cardiac catheterisation revealed a small left to right (1 : 1.6) shunt in case 1, and a large one, 1 : 3, with markedly elevated pulmonary artery pressure in case 2.
COURSE: In case 1, no treatment was needed as the intracardiac shunt was small and there were no symptoms. But in case 2 the large shunt with pulmonary hypertension required operative closure with a Dacron patch 2 days after the diagnosis had been established.
CONCLUSION: Ventricular septal rupture after blunt trauma to the chest is a rare occurrence. Even though in general the prognosis is good, a large intracardiac shunt may require early surgical repair.
INVESTIGATIONS: Echocardiography demonstrated posttraumatic ventricular septal rupture in both patients. Cardiac catheterisation revealed a small left to right (1 : 1.6) shunt in case 1, and a large one, 1 : 3, with markedly elevated pulmonary artery pressure in case 2.
COURSE: In case 1, no treatment was needed as the intracardiac shunt was small and there were no symptoms. But in case 2 the large shunt with pulmonary hypertension required operative closure with a Dacron patch 2 days after the diagnosis had been established.
CONCLUSION: Ventricular septal rupture after blunt trauma to the chest is a rare occurrence. Even though in general the prognosis is good, a large intracardiac shunt may require early surgical repair.