Percutaneous closure of a traumatic ventricular septal defect: a case report
and literature review

Percutaneous closure of a traumatic ventricular septal defect: a case report
and literature review

Penetrating cardiac trauma, Ventricular septal defect, Emergency thoracotomy, Percutaneous closure, Echocardiography

Abstract
Background Penetrating cardiac trauma is an entity with high pre and intrahospital mortality due to complications
such as cardiac tamponade and massive hemothorax. A ventricular septal defect (VSD) occurs in 1–5% of cases and
can present early or late. The management strategy for VSD resulting from penetrating cardiac trauma is uncertain.
Case presentation A 19-year-old man was admitted in cardiorespiratory arrest after a precordial stab wound.
Cardiopulmonary resuscitation was initiated achieving return of spontaneous circulation. eFAST evaluation
revealed cardiac tamponade, he was taken to emergency left thoracotomy finding a perforation of the free wall of
the left ventricle and a tear of the upper lobe of the left lung that were sutured. The patient was discharged and
six days later was readmitted with fever and dyspnea. During treatment for a surgical site infection a new-onset
pansystolic murmur was found: A transthoracic echocardiogram revealed a 13-mm VSD with left-to-right shunt. A
multidisciplinary team recommended percutaneous closure of the defect which was successfully performed without
complications.
Conclusions Traumatic VSD is a rare complication of penetrating cardiac trauma. A thorough clinical and
echocardiographic evaluation is essential for its diagnosis and characterization. Symptomatic septal defects, those
10 mm or larger, with Qp: Qs greater than 1.5, or causing complications such as pulmonary hypertension or valvular
involvement, are usually closed to prevent progression of heart failure. Management of traumatic VSD has traditionally
been surgical. However, a percutaneous intervention is a viable alternative in selected stable patients. Unlike ischemic
VSD, early intervention after patient stabilization generally yields favorable outcomes.
Keywords Penetrating cardiac trauma, Ventricular septal defect, Emergency thoracotomy, Percutaneous closure,
Echocardiography

Camilo Andres Calderon-Miranda1,2*, Maria Juliana Reyes-Cardona3

, Gabriel Roberto Lopez-Mora2,4,
Fernando Andrés Guerrero-Pinedo2,5, Jairo Sanchez-Blanco1,2, Carlos Enrique Vesga-Reyes1,2,
Jorge Alexander Zambrano-Franco1,2 and Pastor Olaya1,2

Abstract
Background Penetrating cardiac trauma is an entity with high pre and intrahospital mortality due to complications
such as cardiac tamponade and massive hemothorax. A ventricular septal defect (VSD) occurs in 1–5% of cases and
can present early or late. The management strategy for VSD resulting from penetrating cardiac trauma is uncertain.
Case presentation A 19-year-old man was admitted in cardiorespiratory arrest after a precordial stab wound.
Cardiopulmonary resuscitation was initiated achieving return of spontaneous circulation. eFAST evaluation
revealed cardiac tamponade, he was taken to emergency left thoracotomy finding a perforation of the free wall of
the left ventricle and a tear of the upper lobe of the left lung that were sutured. The patient was discharged and
six days later was readmitted with fever and dyspnea. During treatment for a surgical site infection a new-onset
pansystolic murmur was found: A transthoracic echocardiogram revealed a 13-mm VSD with left-to-right shunt. A
multidisciplinary team recommended percutaneous closure of the defect which was successfully performed without
complications.
Conclusions Traumatic VSD is a rare complication of penetrating cardiac trauma. A thorough clinical and
echocardiographic evaluation is essential for its diagnosis and characterization. Symptomatic septal defects, those
10 mm or larger, with Qp: Qs greater than 1.5, or causing complications such as pulmonary hypertension or valvular
involvement, are usually closed to prevent progression of heart failure. Management of traumatic VSD has traditionally
been surgical. However, a percutaneous intervention is a viable alternative in selected stable patients. Unlike ischemic
VSD, early intervention after patient stabilization generally yields favorable outcomes.
Keywords Penetrating cardiac trauma, Ventricular septal defect, Emergency thoracotomy, Percutaneous closure,
Echocardiography

2025

Peri Irawan

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