Calderon-Miranda Camilo Andres, Reyes-Cardona Maria Juliana, Lopez-Mora Gabriel Roberto, Guerrero-Pinedo Fernando Andrés, Sanchez-Blanco Jairo, Vesga-Reyes Carlos Enrique, Zambrano-Franco Jorge Alexander, Olaya Pastor
Departamento de Cardiología, Fundación Valle del Lili, Carrera 98 No. 18 - 49, Cali, 760032, Colombia.
Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, 760031, Colombia.
Int J Emerg Med. 2025 Jan 9;18(1):10. doi: 10.1186/s12245-024-00805-z.
Penetrating cardiac trauma is an entity with high pre and intrahospital mortality due to complications such as cardiac tamponade and massive hemothorax. A ventricular septal defect (VSD) occurs in 1-5% of cases and can present early or late. The management strategy for VSD resulting from penetrating cardiac trauma is uncertain.
A 19-year-old man was admitted in cardiorespiratory arrest after a precordial stab wound. Cardiopulmonary resuscitation was initiated achieving return of spontaneous circulation. eFAST evaluation revealed cardiac tamponade, he was taken to emergency left thoracotomy finding a perforation of the free wall of the left ventricle and a tear of the upper lobe of the left lung that were sutured. The patient was discharged and six days later was readmitted with fever and dyspnea. During treatment for a surgical site infection a new-onset pansystolic murmur was found: A transthoracic echocardiogram revealed a 13-mm VSD with left-to-right shunt. A multidisciplinary team recommended percutaneous closure of the defect which was successfully performed without complications.
Traumatic VSD is a rare complication of penetrating cardiac trauma. A thorough clinical and echocardiographic evaluation is essential for its diagnosis and characterization. Symptomatic septal defects, those 10 mm or larger, with Qp: Qs greater than 1.5, or causing complications such as pulmonary hypertension or valvular involvement, are usually closed to prevent progression of heart failure. Management of traumatic VSD has traditionally been surgical. However, a percutaneous intervention is a viable alternative in selected stable patients. Unlike ischemic VSD, early intervention after patient stabilization generally yields favorable outcomes.
穿透性心脏创伤是一种由于心脏压塞和大量血胸等并发症导致院前和院内死亡率较高的疾病。室间隔缺损（VSD）在1%-5%的病例中出现，可早期或晚期表现。穿透性心脏创伤导致的VSD的管理策略尚不确定。
一名19岁男性在胸前刺伤后因心肺骤停入院。开始进行心肺复苏，实现了自主循环恢复。eFAST评估显示心脏压塞，他被送往急诊室进行左胸廓切开术，发现左心室游离壁穿孔和左肺上叶撕裂，进行了缝合。患者出院，六天后因发热和呼吸困难再次入院。在治疗手术部位感染期间，发现了新出现的全收缩期杂音：经胸超声心动图显示一个13毫米的VSD，有左向右分流。一个多学科团队建议经皮封堵缺损，该操作成功完成，无并发症。
创伤性VSD是穿透性心脏创伤的一种罕见并发症。全面的临床和超声心动图评估对其诊断和特征描述至关重要。有症状的间隔缺损，即那些10毫米或更大、Qp:Qs大于1.5或引起诸如肺动脉高压或瓣膜受累等并发症的缺损，通常进行封堵以防止心力衰竭进展。创伤性VSD的管理传统上是手术治疗。然而，经皮干预在选定的稳定患者中是一种可行的替代方法。与缺血性VSD不同，患者稳定后早期干预通常会产生良好的结果。
