Circulation. 2005;112:e339-e340
doi: 10.1161/CIRCULATIONAHA.105.538199
(Circulation. 2005;112:e339-e340.)
© 2005 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Ventricular Septal Rupture After a Nonpenetrating Chest Trauma
Findings From Real-Time Three-Dimensional Echocardiography and Cardiac Magnetic Resonance
Franck Thuny, MD;
Alexis Jacquier, MD;
Alberto Riberi, MD;
Jean-François Avierinos, MD;
Sébastien Renard, MD;
Frédéric Collart, MD;
Xavier Luanika, MD;
Jean-Michel Bartoli, MD;
Dominique Métras, MD;
Gilbert Habib, MD
From the Departments of Cardiology (F.T., J.-F.A., S.R., G.H.), Cardiothoracic Surgery (A.R., F.C., D.M.), and Radiology (A.J., J.-M.B.), Centre Hospitalo-Universitaire de la Timone, Marseille, and the Department of Cardiology (X.L.), Gap, France.
Correspondence to Dr Franck Thuny, Hôpital de la Timone, Département de Cardiologie, Boulevard Jean Moulin, 13005 Marseille, France. E-mail franck.thuny{at}wanadoo.fr
A 19-year-old man with no medical history was involved in a motorcycle accident with chest trauma and rapid deceleration. No injury was apparent initially, but 3 weeks later, he developed dyspnea and was referred to our echocardiography unit for assessment of a new 4/6 systolic heart murmur. 2D echocardiography (Figure 1) and cardiac magnetic resonance (CMR) (Figure 2 and Movie I) showed a large apical ventricular septal defect (VSD) with a left-to-right shunt. Real-time 3D transthoracic echocardiography allowed a better assessment of the defect morphology, showing a rupture extending from the anterior to the inferior part of the interventricular septum (IVS) (Figure 3 and Movies II and III). In view of this traumatic VSD, surgery was performed the day after echocardiography and confirmed the morphology of the defect. The VSD was closed by use of a Dacron patch through the left ventricle (Figure 4). Postoperative 2D and 3D echocardiography showed no residual VSD, and the patient was discharged on day 10.
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Figure 1. 2D echocardiogram in apical (A) and subcostal (B) 4-chamber views showing a large apical VSD (arrow). RV indicates right ventricle; LV, left ventricle.
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Figure 3. Real-time 3D echocardiogram using the "full-volume" mode that consists of the acquisition of a large single pyramid of data (120x60°) recorded during 4 consecutive cardiac cycles. The left ventricle view of the IVS shows a rupture (arrow) extending from the anterior to the inferior part of the septum. PPM indicates posteromedian papillary muscle.
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Figure 4. Perioperative view showing the VSD closure using a Dacron patch through a left ventriculotomy.
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Footnotes
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The online-only Data Supplement, which contains 3 movies, can be found at http://circ.ahajournals.org/cgi/content/full/112/22/e339/DC1.
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Issue Highlights
Circulation 2005 112: 3365.
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