Ventricular septal defects and arteriovenous fistulas, with and without valvular lesions, resulting from penetrating injury of the heart and aorta.

Thirty-one patients with post-traumatic intracardiac shunts or arteriovenous fistulas were treated surgically in the past 8 years. All patients had had penetrating injuries of the heart, ascending aorta, or aortic arch 1 week to 4 years earlier, but only three had an early emergency operation. Eleven patients (35%) had ventricular septal defects and seven (23%) had other types of intracardiac fistulas. The remaining 13 patients had fistulas between the aorta and the main pulmonary artery or innominate vein. Nine patients (29%) had injury of one of the four cardiac valves. All patients but six with aorta-innominate vein fistulas were operated on with the assistance of cardiopulmonary bypass. All affected valves were successfully repaired. There were no operative deaths but two patients (6%) died late. The remaining 29 patients were alive and well when last seen, with no signs of residual shunt and with good valve function. The high prevalence of late complications necessitates routine investigation of patients with penetrating injuries of the heart and the aorta. Surgical correction carries a low mortality and morbidity and is advised in all patients with symptoms.