Journal of Emergencies, Trauma, and Shock
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CASE REPORT
Year : 2012  |  Volume : 5  |  Issue : 4  |  Page : 350-352

A large ventricular septal defect complicating resuscitation after blunt trauma


1 Trauma Clinical and Academic Unit, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
2 Heart and Chest Centre, London Chest Hospital, Bonner Road, London, E2 2JX, United Kingdom

Correspondence Address:
Henry D I De'Ath
Trauma Clinical and Academic Unit, The Royal London Hospital, Whitechapel, London, E1 1BB,
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.102409

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A young adult pedestrian was admitted to hospital after being hit by a car. On arrival to the Accident and Emergency Department, the patient was tachycardic, hypotensive, hypoxic, and acidotic with a Glasgow Coma Scale of 3. Despite initial interventions, the patient remained persistently hypotensive. An echocardiogram demonstrated a traumatic ventricular septal defect (VSD) with right ventricular strain and increased pulmonary artery pressure. Following a period of stabilization, open cardiothoracic surgery was performed and revealed an aneurysmal septum with a single large defect. This was repaired with a bovine patch, resulting in normalization of right ventricular function. This case provides a vivid depiction of a large VSD in a patient following blunt chest trauma with hemodynamic compromise. In all thoracic trauma patients, and particularly those poorly responsive to resuscitation, VSDs should be considered. Relevant investigations and management strategies are discussed.


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