Ventricular Septal Rupture After a Nonpenetrating Chest Trauma
Findings From Real-Time Three-Dimensional Echocardiography and Cardiac Magnetic Resonance
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.
The online-only Data Supplement, which contains 3 movies, can be found at http://circ.ahajournals.org/cgi/content/full/112/22/e339/DC1.