Journal of Emergencies, Trauma, and Shock
Home About us Editors Ahead of Print Current Issue Archives Search Instructions Subscribe Advertise Login 
Users online:529   Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size   


 
 Table of Contents    
CASE REPORT  
Year : 2012  |  Volume : 5  |  Issue : 2  |  Page : 184-187
Ventricular septal defect following blunt chest trauma


1 Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
2 Department of Trauma and Critical Care, Inkosi Albert Luthuli Hospital, Durban, KwaZulu-Natal, South Africa
3 Department of Anaesthetics, Perioperative Research Group and Outcomes Research Consortium, Cleveland, Ohio, Canada

Click here for correspondence address and email

Date of Submission07-Dec-2011
Date of Acceptance18-Jan-2012
Date of Web Publication24-May-2012
 

   Abstract 

We present a 32-year-old male with ventricular septal defect (VSD) following blunt chest trauma. Traumatic VSD is a rare but potentially life-threatening injury, the severity, course and presentation of which are variable. While the diagnosis of myocardial injury may be challenging, cardiac troponins are useful as a screening and diagnostic test. The proposed pathophysiological mechanisms in the development of traumatic VSD are early mechanical rupture and delayed inflammatory rupture. We conducted a literature review to investigate the pathogenesis, distribution of patterns of presentation, and the associated prognoses in patients with VSD following blunt chest trauma. We found that traumatic VSDs diagnosed within 48 hours were more likely to be severe, require emergency surgery and were associated with a higher mortality. Children with traumatic VSDs had an increased mortality risk. Smaller lesions may be managed conservatively but should be followed up to detect late complications. In both groups elective repair was associated with a good outcome.

Keywords: Blunt cardiac injury, blunt chest trauma, post-traumatic, ventricular septal defect

How to cite this article:
Ryan L, Skinner DL, Rodseth RN. Ventricular septal defect following blunt chest trauma. J Emerg Trauma Shock 2012;5:184-7

How to cite this URL:
Ryan L, Skinner DL, Rodseth RN. Ventricular septal defect following blunt chest trauma. J Emerg Trauma Shock [serial online] 2012 [cited 2019 Dec 7];5:184-7. Available from: http://www.onlinejets.org/text.asp?2012/5/2/184/96492



   Introduction Top


Blunt chest trauma may produce a variety of cardiac sequelae, [1],[2] however, VSD is a particularly uncommon result. [3],[4] Its severity, presentation and course are variable, [3],[5],[6],[7],[8] presenting signs are often masked by concomitant injuries, [6] and the presentation of the murmur is often delayed. [2],[6],[7],[9]

We describe a young male who presented with a VSD following blunt chest trauma. This is followed by a literature review of the pathogenesis, patterns of injury and presentation, and associated prognoses in traumatic ventricular septal rupture.


   Case Report Top


A 32-year-old male polytrauma patient presented to the casualty of a peripheral hospital in rural KwaZulu Natal, South Africa following a motor vehicle accident. He required intubation and ventilation, and the following morning was airlifted to the Level 1 Trauma Unit at Inkosi Albert Luthuli Hospital (IALCH), in Durban, KwaZulu Natal, South Africa.

On arrival at IALCH, he had a blood pressure 110/53 mmHg, heart rate 95 beats per minute, and Glasgow Coma Scale (GCS) score E-2, M-5, V-tubed. His initial arterial blood gas on 40% oxygen showed: pO2 12.9 kPa, pCO2 6.3 kPa, pH 7.34, 98% saturation, base deficit 2.5, and lactate 2.4 mmol/L.

Clinical examination revealed significant blunt chest trauma and extensive soft tissue injuries, which included a degloving parietal scalp laceration, and deep abrasions over the right shoulder and knee. Imaging confirmed bilateral hemo/pneumothoraces (for which intercostal drains had been inserted at the peripheral hospital), fractures of the 3 rd -5 th ribs anteriorly and 6 th -10 th ribs posteriorly, with associated bilateral lung contusions. No cardiac murmur was noted on initial presentation. There were no associated brain, cervical spine, or pelvic injuries. On admission, his troponin I was 0.190 ng/ml and B-type natriuretic peptide (BNP) was 59.67 pg/ml (Siemens Advia Centaur Xp). All other blood results were normal.

The patient's soft tissue injuries were debrided on admission and again 2 days later. He was weaned off the ventilator and successfully extubated 4 days after admission. On day 2, the troponin I declined to 0.074 ng/ml. On day 7, the admitting doctor noted a new 2/6 pansystolic murmur in the left parasternal 2 nd -3 rd intercostal space. This raised the suspicion that he may have developed a ventricular septal defect (VSD) secondary to blunt chest trauma. Echocardiographic examination confirmed this diagnosis by identifying left to right flow across the peri-membranous region of the ventricular septum. In addition, a small pericardial effusion around the right ventricle and atrium was noted.

Although the possibility of a pre-existing congenital defect cannot be excluded there is strong evidence supporting the diagnosis of a post-traumatic VSD. First, the pericardial effusion and elevated BNP and troponin I clearly indicate that the patient sustained major cardiac injury. Second, the late presentation of the murmur is consistent with previously described post-traumatic VSDs, and finally, the patient gave no history of prior cardiac abnormalities.

Since this VSD was both small and asymptomatic, and the patient had remained hemodynamically stable since admission, the decision was made to manage the lesion conservatively and to schedule the patient for follow-up by the department of cardiothoracics.


   Discussion Top


We conducted a literature review by searching Pubmed from January 1965 to May 1, 2011 using the following search terms: ventricular septal defect and trauma. We identified 165 studies, 35 of which detailed congenital lesions, 29 described penetrating chest trauma and 13 reported iatrogenic injury following cardiac surgery. We excluded 23 studies as dealing with unrelated topics. In the remaining 65 papers, we identified 68 patients included in 62 case reports, [2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53],[54],[55],[56],[57],[58],[59],[60],[61],[62],[63] 2 retrospective reviews, [64],[65] and 1 prospective evaluation. [66]

The pathogenesis of VSD following blunt chest trauma is unclear but is thought to be caused by either early mechanical rupture or delayed inflammatory rupture. Mechanical septal rupture has been proposed to occur as the heart is compressed during late diastole, after atrial contraction, when the ventricles are filled and the valves closed. This may occur as a result of direct cardiac impact or when the heart is compressed between the sternum and the spine. [3],[5],[7],[8],[11],[15],[20] It has also been suggested that a healed congenital VSD with a weakened ventricular septum may re-open with significant blunt trauma to the chest. [6] Delayed inflammatory rupture is thought to occur when cardiac injury causes localised edema with disruption of microvascular flow, leading to infarction, septal liquefaction, and perforation. [2],[3],[7]

The diagnosis of a VSD following blunt chest trauma may be challenging. Investigation should include elements of the history and clinical examination, as well as information gained from plain chest radiograph, cardiac enzymes, echocardiography, and nuclear imaging studies. [67]

The measurement of cardiac enzymes is fast, simple, and minimally invasive. Creatine phosphokinase myocardial band (CPK-MB) is commonly elevated in polytrauma patients due to non-myocardial sources, rendering its usefulness in the diagnosis of myocardial damage questionable. [67] Since cardiac troponins are only released following disruption of the myocardial cell membrane, they are specific indicators and therefore ideal markers of myocardial damage. Elevation in cardiac troponin I (cTnI) has been shown to be both a sensitive and specific indicator of myocardial cell necrosis, [68],[69] and following blunt chest trauma, levels >1 ng/ml correlate well with trans-esophageal echocardiographic evidence of regional wall motion abnormalities. [70] Myocardial lesions not detectable on echocardiography are suggested by cTnI levels between 0.4-1 ng/ml. [70] It is therefore suggested that cTnI be routinely measured in patients sustaining blunt injury to the chest in an attempt to actively seek evidence for myocardial damage.

Patterns of Injury and Prognosis

To determine the distribution of the presentation of patients subsequently diagnosed with traumatic VSD, we separated patients into two groups according to the time of presentation of the VSD: early - within 48 hours of injury, and late - after 48 hours of injury. In 35 of the cases, the timing of diagnosis was indeterminate. In the remaining 33 cases, 17 were diagnosed early and 16 late.

Cases diagnosed early had larger and more severe VSDs, which often required emergency or elective surgical repair and were associated with a high mortality [Table 1].
Table 1: Management of VSDs diagnosed <48 hours (n=17)

Click here to view


Late presentations rarely required emergency surgery although often underwent elective repair. Three late complications were reported in the group of six patients who did not have their defects corrected. These cases (one presenting with endocarditis and the other two with cardiac failure) required late defect closure [Table 2].
Table 2: Management of VSDs diagnosed >48 hours (n=16)

Click here to view


Of the 16 cases diagnosed after 48 hours, only one patient required emergency repair. Ten patients, including a 4-year-old child, underwent elective repair with no documented complications, while one patient refused surgery and was lost to follow-up.

Small asymptomatic traumatic VSDs may be managed conservatively [5],[37] as they often close spontaneously. [3] Surgical repair is indicated if the defect is large, if the pulmonary to systemic blood flow ratio exceeds 2:1, or if there is evidence of cardiac failure. [3],[8],[37] However, a persisting small lesion with chronic left to right shunting may with time result in right ventricular failure. [3]

Our identification of a bimodal pattern of presentation may reflect the two different pathophysiologies suggested in the literature. These data suggest that VSDs diagnosed within 48 hours are more likely to: be life-threatening, require emergency surgery, and be associated with a higher mortality than those diagnosed later. It is also evident that children with traumatic VSDs have an increased mortality risk.


   Conclusion Top


Ventricular septal defect following blunt chest trauma is a rare but potentially life-threatening complication. Cardiac troponin I has been shown to be a valuable screening and diagnostic tool in the assessment of blunt cardiac injury. Elevated troponin levels, new onset hemodynamic instability, or the development of a new murmur must prompt further echocardiographic investigation.

While it is acceptable to manage smaller lesions conservatively, these patients should be followed up to detect the occurrence of late complications. Large or symptomatic lesions should be surgically repaired. In both the early and late groups, elective repair of the lesion is associated with a good outcome.

 
   References Top

1.Rollins MD, Koehler RP, Stevens MH, Walsh KJ, Doty DB, Price RS, et al. Traumatic ventricular septal defect: Case report and review of the English literature since 1970. J Trauma 2005;58:175-80.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Mason DT, Roberts WC. Isolated ventricular septal defect caused by nonpenetrating trauma to the chest. Proc (Bayl Univ Med Cent) 2002;15:388-90.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Pierli C, Iadanza A, Del Pasqua A, Sinicropi G. Unusual localisation of a ventricular septal defect following blunt chest trauma. Heart 2001;86:E6.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Pruitt CM, Titus MO. Ventricular septal defect secondary to a unique mechanism of blunt trauma: A case report. Pediatr Emerg Care 2007;23:31-2.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Genoni M, Jenni R, Turina M. Traumatic ventricular septal defect. Heart 1997;78:316-8.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Rootman DB, Latter D, Admed N. Case report of ventricular septal defect secondary to blunt chest trauma. Can J Surg 2007;50:227-8.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Amorim MJ, Almeida J, Santos A, Bastos PT. Atrioventricular septal defect following blunt chest trauma. Eur J Cardiothorac Surg 1999;16:679-82.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Sawhney J, Patel PH, Blackwell RA. Early progression of an isolated ventricular septal defect after blunt trauma. J Trauma 2008;64:218-20.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Olivier LR, Rossouw DS, de Villiers SJ, Vermeulen WA, Stevens MS. Ventricular septal defect due to blunt chest trauma. A case report. S Afr Med J 1983;63:660-2.  Back to cited text no. 9
[PUBMED]    
10.Kim YM, Yoo BW, Choi JY, Sul JH, Park YH. Traumatic ventricular septal defect in a 4-year-old boy after blunt chest injury. Korean J Pediatr 2011;54:86-9.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  
11.Zamani J, Amirghofran AA, Moaref AR, Afifi S, Rezaian GR. Posttraumatic coronary artery-right ventricular fistula with multiple ventricular septal defects. J Card Surg 2010;25:670-1.  Back to cited text no. 11
[PUBMED]  [FULLTEXT]  
12.Blasco PB, Comas JG, del Alcazar Munoz R. Spontaneous improvement of a haemodynamically significant ventricular septal defect produced by blunt chest trauma in a child. Cardiol Young 2009;19:109-10.  Back to cited text no. 12
    
13.Smejkal K, Parizkova R, Harrer J, Lukes A, Koudelka J, Zvak I. Rupture of the interventricular septum after the blunt trauma of thorax. Rozhl Chir 2008;87:76-9.  Back to cited text no. 13
    
14.Ozay B, Ozer N, Ketenci B, Demirtas M. Unsuspected location of a ventricular septal defect after blunt chest trauma. Thorac Cardiovasc Surg 2008;56:110-1.  Back to cited text no. 14
    
15.Gundogdu F, Gurlertop Y, Arslan S, Kocak H, Karakelleoglu S, Atesal S. Ventricular septal rupture and mitral regurgitation caused by trauma. Echocardiography 2007;24:174-5.  Back to cited text no. 15
    
16.Hojo H, Ozaki M, Ogiwara M, Yokote Y, Kyo S. [Ventricular septal perforation due to weak blunt chest trauma; report of a case]. Kyobu Geka 2007;60:149-52.  Back to cited text no. 16
[PUBMED]    
17.Closey DN, Long G, Lin Z, Mehrota D, Havill JH. Isolated ventricular septal defect secondary to low-velocity blunt chest trauma. Crit Care Resusc 2001;3:95-6.  Back to cited text no. 17
[PUBMED]    
18.Bauriedel G, Redel DA, Welz A, Eckert HG, Omran H, Luderitz B. [Ventricular septal defect following cardiac trauma: Closure with the Amplatzer Septal Occluder]. Dtsch Med Wochenschr 2000;125:T8-13.  Back to cited text no. 18
    
19.Salehian O, Mulji A. Tricuspid valve disruption and ventricular septal defect secondary to blunt chest trauma. Can J Cardiol 2004;20:231-2.  Back to cited text no. 19
[PUBMED]    
20.Stamm C, Feit LR, Geva T, del Nido PJ. Repair of ventricular septal defect and left ventricular aneurysm following blunt chest trauma. Eur J Cardiothorac Surg 2002;22:154-6.  Back to cited text no. 20
[PUBMED]  [FULLTEXT]  
21.Tiao GM, Griffith PM, Szmuszkovicz JR, Mahour GH. Cardiac and great vessel injuries in children after blunt trauma: An institutional review. J Pediatr Surg 2000;35:1656-60.  Back to cited text no. 21
[PUBMED]  [FULLTEXT]  
22.Terui G, Kaneko K, Miura M, Kawazoe K. Ventricular septal defect secondary to non-penetrating chest trauma. Jpn Circ J 1997;61:951-3.  Back to cited text no. 22
[PUBMED]  [FULLTEXT]  
23.Curzen N, Brett S, Fox K. Concrete induced cardiac contusion. Heart 1997;78:313-5.  Back to cited text no. 23
[PUBMED]  [FULLTEXT]  
24.Stahl RD, Liu JC, Walsh JF. Blunt cardiac trauma: Atrioventricular valve disruption and ventricular septal defect. Ann Thorac Surg 1997;64:1466-8.  Back to cited text no. 24
[PUBMED]  [FULLTEXT]  
25.Bortolotti U, Milano A, Scioti G, Tartarini G. Post-traumatic ventricular septal defect following coronary bypass surgery. Clin Cardiol 1997;20:660-1.  Back to cited text no. 25
[PUBMED]    
26.Aiba M, Takaba T, Yamada M, Murakami A, Sekiguchi S, Lee M. Isolated rupture of the ventricular septum caused by nonpenetrating trauma--a case report of operation in acute stage. Nihon Kyobu Geka Gakkai Zasshi 1996;44:548-52.  Back to cited text no. 26
[PUBMED]    
27.Wu JJ, Yu TJ, Wang JJ, Wen YS, Liu M, Lee CH. Early repair of traumatic ventricular septal defect and mitral valve regurgitation. J Trauma 1995;39:1191-3.  Back to cited text no. 27
[PUBMED]  [FULLTEXT]  
28.Harel Y, Szeinberg A, Scott WA, Frand M, Vered Z, Smolinski A, et al. Ruptured interventricular septum after blunt chest trauma: Ultrasonographic diagnosis. Pediatr Cardiol 1995;16:127-30.  Back to cited text no. 28
    
29.End A, Rodler S, Oturanlar D, Muller MR, Jaskulka R, Grabenwoger F, et al. [Surgery of blunt heart trauma]. Chirurg 1992;63:641-6.  Back to cited text no. 29
    
30.End A, Rodler S, Oturanlar D, Domanig E, Havel M, Kassal H, et al. Elective surgery for blunt cardiac trauma. J Trauma 1994;37:798-802.  Back to cited text no. 30
    
31.Rutherford EJ, White KS, Maxwell JG, Clancy TV. Immediate isolated interventricular septal defect from nonpenetrating thoracic trauma. Am Surg 1993;59:353-4.  Back to cited text no. 31
[PUBMED]    
32.Jebara VA, Acar C, Dervanian P, Farge A, Sousa Uva M, Julia P, et al. Traumatic ventricular septal defects. Report of 3 cases with tricuspid valve rupture in 2 cases. J Cardiovasc Surg (Torino) 1992;33:253-5.  Back to cited text no. 32
[PUBMED]    
33.Ilia R, Goldfarb B, Wanderman KL, Gueron M. Spontaneous closure of a traumatic ventricular septal defect after blunt trauma documented by serial echocardiography. J Am Soc Echocardiogr 1992;5:203-5.  Back to cited text no. 33
[PUBMED]    
34.Dieter RA 3rd, Anderson AE. Ventricular septal defect caused by nonpenetrating trauma in a 3-year-old child: Use of extracorporeal membrane oxygenation in preoperative stabilization. J Tenn Med Assoc 1991;84:492-3.  Back to cited text no. 34
[PUBMED]    
35.Moront M, Lefrak EA, Akl BF. Traumatic rupture of the interventricular septum and tricuspid valve: Case report. J Trauma 1991;31:134-6.  Back to cited text no. 35
[PUBMED]    
36.Jacob JL, Cury MV, Cury JJ, Garzon SA, Lorga AM, Thevenard RS, et al. Traumatic ventricular septal defect. A case report. Arq Bras Cardiol 1990;54:133-5.  Back to cited text no. 36
    
37.Renzulli A, Wren C, Hilton CJ. Coronary artery-left ventricular fistula and multiple ventricular septal defects due to blunt chest trauma. Thorax 1989;44:1055-6.  Back to cited text no. 37
[PUBMED]  [FULLTEXT]  
38.Sparrow JG, Miller DW Jr. Ventricular septal defect following blunt thoracic and abdominal trauma: Case report. J Trauma 1989;29:690-3.  Back to cited text no. 38
[PUBMED]    
39.Matthews RV, French WJ, Criley JM. Chest trauma and subvalvular left ventricular aneurysms. Chest 1989;95:474-6.  Back to cited text no. 39
[PUBMED]  [FULLTEXT]  
40.Berkery W, Hare C, Warner RA, Battaglia J, Potts JL. Nonpenetrating traumatic rupture of the tricuspid valve. Formation of ventricular septal aneurysm and subsequent septal necrosis: Recognition by two-dimensional Doppler echocardiography. Chest 1987;91:778-80.  Back to cited text no. 40
[PUBMED]    
41.Knapp JF, Sharma V, Wasserman G, Hoover CJ, Walsh I. Ventricular septal defect following blunt chest trauma in childhood: A case report. Pediatr Emerg Care 1986;2:242-3.  Back to cited text no. 41
[PUBMED]    
42.Evora PR, Ribeiro PJ, Brasil JC, Otaviano AG, Amaral FT, Reis CL, et al. Late surgical repair of ventricular septal defect due to nonpenetrating chest trauma: Review and report of two contrasting cases. J Trauma 1985;25:1007-9.  Back to cited text no. 42
[PUBMED]    
43.Merzel DI, Stirling MC, Custer JR. Massive fatal ventricular septal defect due to nonpenetrating chest trauma in a six-year-old boy: The role of early invasive monitoring in an evolving lesion. Pediatr Emerg Care 1985;1:138-42.  Back to cited text no. 43
[PUBMED]    
44.Ollivier JP, Boschat J, Gandjbakhch I, Meudic A, Blanc JJ, Penther P, et al. [Acquired interventricular communication and false left ventricular aneurysm caused by non-penetrating trauma of the thorax]. Arch Mal Coeur Vaiss 1983;76:747-50.  Back to cited text no. 44
[PUBMED]    
45.Khuddus SA, Bolooki H, Rashid A, Kadivar H, Meyer WH Jr. Successful repair of interventricular septal defect resulting from blunt chest trauma. J Fla Med Assoc 1981;68:438-40.  Back to cited text no. 45
[PUBMED]    
46.Pickard LR, Mattox KL, Beall AC Jr. Ventricular septal defect from blunt chest injury. J Trauma 1980;20:329-31.  Back to cited text no. 46
[PUBMED]    
47.Danzl DF, Thomas DM, Miller JW. Ventricular septal defect following blunt chest trauma. Ann Emerg Med 1980;9:150-4.  Back to cited text no. 47
[PUBMED]  [FULLTEXT]  
48.Pellegrini RV, Layton TR, Dimarco RF, Grant KJ, Marrangoni AG. Multiple cardiac lesions from blunt trauma. J Trauma 1980;20:169-73.  Back to cited text no. 48
[PUBMED]    
49.Stephenson LW, MacVaugh H 3rd, Kastor JA. Tricuspid valvular incompetence and rupture of the ventricular septum caused by nonpenetrating trauma. J Thorac Cardiovasc Surg 1979;77:768-72.  Back to cited text no. 49
[PUBMED]    
50.Kreuzer E, Beyer J. [Isolated left ventricular-right atrial shunt after blunt chest trauma (author's transl)]. Thoraxchir Vask Chir 1978;26:398-401.  Back to cited text no. 50
[PUBMED]    
51.Krajcer Z, Cooley DA, Leachman RD. Ventricular septal defect following blunt trauma: Spontaneous closure of residual defect after surgical repair. Cathet Cardiovasc Diagn 1977;3:409-15.  Back to cited text no. 51
[PUBMED]    
52.Anyanwu CH. Mitral incompetence and ventricular septal defects following non-penetrating injury. Thorax 1976;31:113-7.  Back to cited text no. 52
[PUBMED]  [FULLTEXT]  
53.Mossler U, Storch HH, Schmitz W, Ahmadi A, Walther H, Ostermeyer J, et al. Isolated rupture of the interventricular septum after blunt chest trauma (author's transl). Thoraxchir Vask Chir 1975;23:578-83.  Back to cited text no. 53
    
54.Moraes CR, Victor E, Arruda M, Cavalcanti I, Raposo L, Lagreca JR, et al. Ventricular septal defect following nonpenetrating trauma. Case report and review of the surgical literature. Angiology 1973;24:222-9.  Back to cited text no. 54
[PUBMED]  [FULLTEXT]  
55.Goggin MJ, Thompson FD, Jackson JW. Deceleration trauma to the heart and great vessels after road-traffic accidents. Br Med J 1970;2:767-9.  Back to cited text no. 55
[PUBMED]  [FULLTEXT]  
56.Rotman M, Peter RH, Sealy WC, Morris JJ Jr. Traumatic ventricular septal defect secondary to nonpenetrating chest trauma. Am J Med 1970;48:127-31.  Back to cited text no. 56
[PUBMED]  [FULLTEXT]  
57.Scheinman JI, Kelminson LL, Vogel JH, Rosenkrantz JG. Early repair of ventricular septal defect due to nonpenetrating trauma. J Pediatr 1969;74:406-12.  Back to cited text no. 57
[PUBMED]    
58.Stinson EB, Rowles DF, Shumway NE. Repair of right ventricular aneurysm and ventricular septal defect caused by nonpenetrating cardiac trauma. Surgery 1968;64:1022-6.  Back to cited text no. 58
[PUBMED]    
59.Dunseth W, Ferguson TB. Acquired Cardiac Septal Defect Due to Thoracic Trauma. J Trauma 1965;5:142-9.  Back to cited text no. 59
[PUBMED]    
60.Viola AR, Degrossi FP, Vicario DJ, Zuffardi EA. Acquired ventricular septal defect due to blunt trauma of the chest. Am J Cardiol 1964;14:714-6.  Back to cited text no. 60
[PUBMED]    
61.Desforges G, Abelmann WH. Interventricular septal defect to blunt trauma. Report of a case repaired surgically under total cardiopulmonary bypass. N Engl J Med 1963;268:128-31.  Back to cited text no. 61
[PUBMED]  [FULLTEXT]  
62.Sapirstein W, Bigelow WG. Ventricular septal defect due to non-penetrating chest trauma: Report of a case with surgical correction. Can J Surg 1961;4:226-8.  Back to cited text no. 62
[PUBMED]    
63.Cleland WP, Ellman P, Goodwin J, Hollman A. Repair of ventricular septal defect following indirect trauma. Br J Dis Chest 1961;55:17-22.  Back to cited text no. 63
[PUBMED]    
64.Dowd MD, Krug S. Pediatric blunt cardiac injury: Epidemiology, clinical features, and diagnosis. Pediatric Emergency Medicine Collaborative Research Committee: Working Group on Blunt Cardiac Injury. J Trauma 1996;40:61-7.  Back to cited text no. 64
[PUBMED]  [FULLTEXT]  
65.Bromberg BI, Mazziotti MV, Canter CE, Spray TL, Strauss AW, Foglia RP. Recognition and management of nonpenetrating cardiac trauma in children. J Pediatr 1996;128:536-41.  Back to cited text no. 65
[PUBMED]  [FULLTEXT]  
66.Helling TS, Duke P, Beggs CW, Crouse LJ. A prospective evaluation of 68 patients suffering blunt chest trauma for evidence of cardiac injury. J Trauma 1989;29:961-5; discussion 65-6.  Back to cited text no. 66
[PUBMED]    
67.Bansal MK, Maraj S, Chewaproug D, Amanullah A. Myocardial contusion injury: Redefining the diagnostic algorithm. Emerg Med J 2005;22:465-9.  Back to cited text no. 67
[PUBMED]  [FULLTEXT]  
68.Adams JE 3rd, Bodor GS, Davila-Roman VG, Delmez JA, Apple FS, Ladenson JH, et al. Cardiac troponin I. A marker with high specificity for cardiac injury. Circulation 1993;88:101-6.  Back to cited text no. 68
    
69.Collins JN, Cole FJ, Weireter LJ, Riblet JL, Britt LD. The usefulness of serum troponin levels in evaluating cardiac injury. Am Surg 2001;67:821-5; discussion 25-6.  Back to cited text no. 69
[PUBMED]    
70.Mori F, Zuppiroli A, Ognibene A, Favilli S, Galeota G, Peris A, et al. Cardiac contusion in blunt chest trauma: A combined study of transesophageal echocardiography and cardiac troponin I determination. Ital Heart J 2001;2:222-7.  Back to cited text no. 70
[PUBMED]    

Top
Correspondence Address:
Lisa Ryan
Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal
South Africa
Login to access the Email id

Source of Support: Dr. Rodseth is supported by a CIHR Scholarship (the Canada-HOPE Scholarship), the College of Medicine of South Africa (the Phyllis Kocker/Bradlow Award), and the University of KwaZulu-Natal (competitive research grant), Conflict of Interest: None


DOI: 10.4103/0974-2700.96492

Rights and Permissions



 
 
    Tables

  [Table 1], [Table 2]

This article has been cited by
1 Transcatheter device closure of a traumatic ventricular septal defect
Kasem, M., Kanthimathinathan, H.K., Mehta, C., Neal, R., Stumper, O.
Annals of Pediatric Cardiology. 2014;
[Pubmed]
2 Blunt Chest Trauma Resulting in Both Atrial and Ventricular Septal Defects
Yahaira Ortiz,Adam J. Waldman,Jeff N. Bott,Steve J. Carlan,Mario Madruga
Echocardiography. 2014; : n/a
[Pubmed] | [DOI]
3 Multiple ventricular septal rupture after blunt trauma
Pillai, R.S. and Prasad, P. and Nair, R.G. and Pillai, S.B. and Puthenveetil, B.T. and Kuriakose, K.M.
Annals of Thoracic Surgery. 2013; 96(1): 297-298
[Pubmed]
4 VSD following blunt cardiac trauma: MRI findings
Andrew E. Liguori,Benjamin A. Maertins,Randy Richardson
Emergency Radiology. 2013; 20(5): 459
[Pubmed] | [DOI]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed2251    
    Printed146    
    Emailed0    
    PDF Downloaded15    
    Comments [Add]    
    Cited by others 4    

Recommend this journal