De'Ath Henry D I, Vulliamy Paul E D, Davies Ceri, Uppal Rakesh
Trauma Clinical and Academic Unit, The Royal London Hospital, Whitechapel, London, E1 1BB,, United Kingdom.
J Emerg Trauma Shock. 2012 Oct;5(4):350-2. doi: 10.4103/0974-2700.102409.
A young adult pedestrian was admitted to hospital after being hit by a car. On arrival to the Accident and Emergency Department, the patient was tachycardic, hypotensive, hypoxic, and acidotic with a Glasgow Coma Scale of 3. Despite initial interventions, the patient remained persistently hypotensive. An echocardiogram demonstrated a traumatic ventricular septal defect (VSD) with right ventricular strain and increased pulmonary artery pressure. Following a period of stabilization, open cardiothoracic surgery was performed and revealed an aneurysmal septum with a single large defect. This was repaired with a bovine patch, resulting in normalization of right ventricular function. This case provides a vivid depiction of a large VSD in a patient following blunt chest trauma with hemodynamic compromise. In all thoracic trauma patients, and particularly those poorly responsive to resuscitation, VSDs should be considered. Relevant investigations and management strategies are discussed.
一名年轻成人行人被汽车撞后被送往医院。到达急诊部时，患者心动过速、低血压、低氧血症且酸中毒，格拉斯哥昏迷量表评分为3分。尽管进行了初步干预，患者仍持续低血压。超声心动图显示有创伤性室间隔缺损（VSD），右心室劳损且肺动脉压力升高。经过一段时间的稳定后，进行了开胸心脏手术，发现有一个带有单一大缺损的动脉瘤样隔膜。用牛心包补片进行了修复，右心室功能恢复正常。该病例生动地描述了钝性胸部创伤后伴有血流动力学损害的患者出现大型室间隔缺损的情况。在所有胸部创伤患者中，尤其是那些对复苏反应不佳的患者，应考虑室间隔缺损。文中讨论了相关的检查和管理策略。
