Asian Cardiovasc Thorac Ann 2008;16:436
© 2008 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Traumatic Ventricular Septal Defect
Man-Hong Jim, MD,
Yui-Ming Lam, MD1,
Chung-Wah Siu, MD1,
Raymond Hon-Wah Chan, MD1
Cardiac Medical Unit, Grantham Hospital
1 Department of Medicine, Queen Mary Hospital, Hong Kong, China
For reprint information contact: Man-Hong Jim, MD, Tel: 852 2518 2619, Fax: 852 2518 8558, Email: jimmanh2002{at}yahoo.com, The Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong, China.
A 32-year-old Pakistani man was assaulted by two men with knives, resulting in multiple stab wounds over the body and a severe traumatic left chest injury causing left hemothorax. An emergency left anterior thoracotomy was performed. Lacerations were found in the left ventricle, pericardium, pleura, and the lung, all of which were immediately repaired. Postoperatively, the patient could not be weaned off the ventilator, and a loud pansystolic murmur was detected. Transesophageal echocardiography revealed a large ventricular septal defect of 1.4 cm in diameter in the mid-septum (Figure 1
). Cardiac catheterization showed an O2-saturation step-up in the right ventricle; the calculated pulmonary-to-systemic shunt ratio was 12.5. Left ventriculography demonstrated a large smooth-edged ventricular septal defect in the mid septum (Figure 2). A second open heart repair was subsequently performed.
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Figure 1. Transesophageal echocardiography in transgastric view showing a large ventricular septal defect.
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Figure 2. Left ventriculography in left anterior oblique view demonstrating a rectangular smooth-edged ventricular septal defect in the mid-septum.
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