Merzel D I, Stirling M C, Custer J R
Pediatr Emerg Care. 1985 Sep;1(3):138-42. doi: 10.1097/00006565-198509000-00007.
Isolated ventricular septal defects due to nonpenetrating chest trauma are unusual lesions in adults and very rare in children. A review of the literature and of the natural course of traumatic ventricular septal defects is discussed, with emphasis on the evolving course and frequent late appearance of this lesion. Surgical closure is the treatment of choice, most often performed electively following medical treatment. Defects resulting in progressive severe congestive heart failure must be repaired emergently. The key to successful outcome is early suspicion of such a defect in the presence of heart failure following a period of relative cardiovascular stability. Anticipation of evolving myocardial dysfunction in the presence of seemingly minor chest wall injury and nonspecific electrocardiographic changes is emphasized. A case of a fatal traumatic ventricular septal defect is presented. The importance of early invasive monitoring with proper interpretation of hemodynamic data is discussed.
因非穿透性胸部创伤导致的孤立性室间隔缺损在成人中是不常见的病变，在儿童中极为罕见。本文讨论了有关创伤性室间隔缺损的文献综述及其自然病程，重点在于该病变的演变过程及常见的延迟出现情况。手术闭合是首选治疗方法，多数情况下在药物治疗后择期进行。导致进行性严重充血性心力衰竭的缺损必须紧急修复。成功治疗的关键在于在经历一段相对心血管稳定期后出现心力衰竭时，早期怀疑存在此类缺损。强调在看似轻微的胸壁损伤和非特异性心电图改变情况下，对逐渐发展的心肌功能障碍的预判。本文还介绍了一例致命性创伤性室间隔缺损病例。讨论了早期有创监测及正确解读血流动力学数据的重要性。
