A Case of Early Repair of Ventricular Septal Perforation due to Blunt Chest Trauma

Takeshi Ikuta Shigefumi Suehiro Toshihiko Shibata
Yasuyuki Sasaki Hidekazu Hirai Tadahiro Murakami
Mitsuharu Hosono Hiromichi Fujii Takanobu Aoyama
Hiroaki Kinoshita

(Department of Cardiovascular Surgery, Osaka City University Medical School, Osaka, Japan)

We report a 25-year-old man with ventricular septal perforation due to blunt chest trauma. He was transferred by ambulance to our hospital following a traffic accident. On admission, he had no cardiac murmur. Two days later, a pansystolic murmur appeared over the left lower sternal border. Doppler echocardiogram revealed a large left-to-right shunt through a ventricular septal perforation. We postponed surgical treatment as long as possible because he also exhibited bronchial bleeding due to a lung contusion. Surgical repair of the ruptured ventricular septum was performed 8 days after the chest trauma, because the pulmonary to systemic flow ratio was elevated to 4.6 and cardiac function had deteriorated. During the operation, the site of the septal perforation was easily detected by epicardial echocardiography. A 4-cm tear in the muscular septum was closed through a right ventriculotomy using a pericardial patch reinforced with a Dacron patch. Postoperative recovery was uneventful with the exception of transient right ventricular failure. There was no residual shunt.   
 Jpn. J. Cardiovasc. Surg. 31: 221-223 (2002)