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Muacevic A, Adler JR, Satyadi M, Keita P, Nobles A, Misselbeck T, Kluck B. Traumatic Atrial Septal Defect Repair via Primary Endovascular Suture Method: Case Report and Operative Technique. Cureus 2023; 15:e33679. [PMID: 36788870 PMCID: PMC9918876 DOI: 10.7759/cureus.33679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
We report a case of a 20-year-old male with no prior medical history who was found to have an atrial septal defect on echocardiography following a motor vehicle accident (MVA). The patient underwent primary percutaneous defect closure using the NobleStitch EL (Heartstitch, Fountain Valley, California) cardiovascular suturing system with intra-operative Doppler echocardiogram showing no residual shunt or color flow. There were no operative complications. At five months follow-up, the patient reported no symptoms from the procedure. In the case of traumatic atrial septal defect repair, the NobleStitch EL system may be utilized as an alternative to open heart surgery.
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2
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Muscogiuri G, Guaricci AI, Soldato N, Cau R, Saba L, Siena P, Tarsitano MG, Giannetta E, Sala D, Sganzerla P, Gatti M, Faletti R, Senatieri A, Chierchia G, Pontone G, Marra P, Rabbat MG, Sironi S. Multimodality Imaging of Sudden Cardiac Death and Acute Complications in Acute Coronary Syndrome. J Clin Med 2022; 11:jcm11195663. [PMID: 36233531 PMCID: PMC9573273 DOI: 10.3390/jcm11195663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/07/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Sudden cardiac death (SCD) is a potentially fatal event usually caused by a cardiac arrhythmia, which is often the result of coronary artery disease (CAD). Up to 80% of patients suffering from SCD have concomitant CAD. Arrhythmic complications may occur in patients with acute coronary syndrome (ACS) before admission, during revascularization procedures, and in hospital intensive care monitoring. In addition, about 20% of patients who survive cardiac arrest develop a transmural myocardial infarction (MI). Prevention of ACS can be evaluated in selected patients using cardiac computed tomography angiography (CCTA), while diagnosis can be depicted using electrocardiography (ECG), and complications can be evaluated with cardiac magnetic resonance (CMR) and echocardiography. CCTA can evaluate plaque, burden of disease, stenosis, and adverse plaque characteristics, in patients with chest pain. ECG and echocardiography are the first-line tests for ACS and are affordable and useful for diagnosis. CMR can evaluate function and the presence of complications after ACS, such as development of ventricular thrombus and presence of myocardial tissue characterization abnormalities that can be the substrate of ventricular arrhythmias.
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Affiliation(s)
- Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Piazzale Brescia 20, 20149 Milan, Italy
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
- Correspondence:
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Nicola Soldato
- University Cardiology Unit, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09124 Cagliari, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09124 Cagliari, Italy
| | - Paola Siena
- University Cardiology Unit, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Maria Grazia Tarsitano
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Davide Sala
- Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Paolo Sganzerla
- Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy
| | - Alberto Senatieri
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
| | | | | | - Paolo Marra
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Mark G. Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, IL 60611, USA
- Edward Hines Jr. VA Hospital, Hines, IL 60141, USA
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
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3
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Anthony Zimmerman S, McGrew PR. Stab Wound to the Right Ventricle With Creation of Ventricular Septal Defect Managed With an Endovascular Occlusive Patch. Am Surg 2022; 88:1893-1895. [PMID: 35392667 DOI: 10.1177/00031348221085667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Penetrating trauma to the cardiac box is associated with high rates of cardiac injury, structural complications, morbidity, and mortality. Early identification and intervention of these injuries is paramount to obtaining good patient outcomes. In this paper, we report a 55-year-old male who sustained a single stab wound to left chest which perforated the right ventricle. The patient also sustained a muscular ventricular septal defect (VSD) which led to a prolonged intensive care unit (ICU) course complicated by late pericardial tamponade. We present successful management of this patient's initial injury along with his ICU course culminating in successful endovascular occlusive patch VSD repair.
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Affiliation(s)
- S Anthony Zimmerman
- University Medical Center New Orleans, New Orleans, LA, USA.,Department of Surgery, 12258Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Patrick R McGrew
- University Medical Center New Orleans, New Orleans, LA, USA.,Department of Surgery, 12255Tulane University, New Orleans, LA, USA
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4
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Lee YC, Li JY. Delayed Complication of Penetrating Cardiac Injury: Traumatic VSD. ACTA CARDIOLOGICA SINICA 2021; 37:554-556. [PMID: 34584390 DOI: 10.6515/acs.202109_37(5).20210412a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/12/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Ying-Chun Lee
- Division of Cardiovascular Surgery, Department of Surgery, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Jiun-Yi Li
- Division of Cardiovascular Surgery, Department of Surgery, Taitung MacKay Memorial Hospital, Taitung, Taiwan
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5
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Qamar SR, Wu Y, Nicolaou S, Murray N. State of the Art Imaging Review of Blunt and Penetrating Cardiac Trauma. Can Assoc Radiol J 2020; 71:301-312. [PMID: 32066272 DOI: 10.1177/0846537119899200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Traumatic cardiovascular injuries are only second to the central nervous system injuries as a cause of death in young adult population. Multidetector computed tomography is the gold standard diagnostic modality in patients with blunt or penetrating chest trauma and clinical suspicion of cardiac injury. The imaging spectrum of cardiac injuries includes but not limits to pericardial rupture, myocardial contusions, valve rupture, coronary artery injuries, cardiac herniations, and cardiac tamponade. In this review article, we discuss clinical presentation, types, and mechanism of cardiac trauma with emphasis on the imaging findings and illustrations in blunt, penetrating traumatic, and iatrogenic cardiac injuries.
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Affiliation(s)
- Sadia Raheez Qamar
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yuhao Wu
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Savvas Nicolaou
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Murray
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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7
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Abstract
The purpose of this article was to review the pathophysiology, imaging features, and imaging pitfalls of noncongenital ventricular septal defects (VSDs). Noncongenital VSDs can result from ischemic heart disease, trauma, infection, and iatrogenic causes. Ischemic VSDs typically involve the posterior descending or left anterior descending vascular territories and are commonly seen in the apical septum or basal-mid inferoseptum. VSDs can also occur in patients with infectious endocarditis or as a complication following cardiac surgery. Most of these involve the membranous portion of the interventricular septum. Traumatic VSDs are rare and commonly involve the mid to apical anteroseptum. Computed tomography and magnetic resonance imaging can accurately characterize the morphologic features of the defects and associated imaging findings.
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8
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Saker E, Bahri GN, Montalbano MJ, Johal J, Graham RA, Tardieu GG, Loukas M, Tubbs RS. Gerbode defect: A comprehensive review of its history, anatomy, embryology, pathophysiology, diagnosis, and treatment. J Saudi Heart Assoc 2017; 29:283-292. [PMID: 28983172 PMCID: PMC5623025 DOI: 10.1016/j.jsha.2017.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/24/2016] [Accepted: 01/26/2017] [Indexed: 11/18/2022] Open
Abstract
The purpose of this paper is to survey the literature on Gerbode defect and provide an overview of its history, anatomy, development, pathophysiology, diagnosis, and treatment options. The available literature on this topic, including case reports, was thoroughly reviewed. Gerbode defect is defined as abnormal shunting between the left ventricle and right atrium resulting from either a congenital defect or prior cardiac insults. The pathophysiology underlying the development of Gerbode defect is a disease process that injures the atrioventricular septum and leads to the abnormal shunting of blood. Although the most prevalent cause of Gerbode defect has historically been congenital, an increasing trend towards acquired cases has recently been reported owing to improved diagnostic capabilities and a greater number of invasive cardiac procedures. In conclusion, Gerbode defect is an increasingly recognized condition that warrants further study.
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Affiliation(s)
- Erfanul Saker
- Department of Anatomical Sciences, St. George’s University, West Indies, Grenada
- Corresponding author at: 37–15 78th Street, Jackson Heights, NY 11372, USA.37–15 78th StreetJackson HeightsNY11372USA
| | - Ghazal N. Bahri
- Department of Anatomical Sciences, St. George’s University, West Indies, Grenada
| | | | - Jaspreet Johal
- Department of Anatomical Sciences, St. George’s University, West Indies, Grenada
| | - Rachel A. Graham
- Department of Pathobiology, The Sophie Davis School of Biomedical Education, City College of New York, NY, USA
| | - Gabrielle G. Tardieu
- Department of Anatomical Sciences, St. George’s University, West Indies, Grenada
| | - Marios Loukas
- Department of Anatomical Sciences, St. George’s University, West Indies, Grenada
| | - R. Shane Tubbs
- Department of Anatomical Sciences, St. George’s University, West Indies, Grenada
- Department of Neurosurgery, Seattle Science Foundation, Seattle, WA, USA
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9
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Cuddy S, Kolcow W, Smyth Y, Mylotte D. Young Male With Stab Wound. Ann Emerg Med 2017; 69:171-201. [DOI: 10.1016/j.annemergmed.2016.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Indexed: 11/27/2022]
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10
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Tang L, Tang JJ, Fang ZF, Hu XQ, Shen XQ, Zhou SH. Severe Mechanical Hemolysis After Transcatheter Closure of a Traumatic Ventricular Septal Defect Using the Amplatzer Atrial Septal Occluder. Int Heart J 2016; 57:519-21. [PMID: 27357435 DOI: 10.1536/ihj.15-407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Traumatic ventricular septal defect (VSD) resulting from chest trauma, either penetrating or blunt, is a relatively rare occurrence. Herein, we describe the case of a previously healthy 26-year-old man who presented with congestive heart failure, which was secondary to a large traumatic VSD following violent blunt chest trauma. The traumatic VSD was initially closed percutaneously using an Amplatzer atrial septal defect occluder. Post-device closure, however, the patient developed severe intravascular hemolysis refractory to medical treatment. The patient subsequently underwent surgical removal of the Amplatzer device, with concomitant VSD patch closure.
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Affiliation(s)
- Liang Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University
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11
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Abstract
This report describes the ability of computed tomography angiography (CTA) imaging of the heart to visualize an acquired shunt between the left ventricular outflow tract (LVOT) and the right atrium (RA) (Gerbode defect). Previously, transesophageal echocardiography (TEE) has been the mainstay of diagnosis. To the best of our knowledge, the use of cardiac CTA imaging to visualize and diagnose this disorder has not been previously reported. Cardiac CTA allows for more detailed visualization of cardiac anatomy and can supplement or supplant TEE as the diagnostic test of choice for evaluation of patients with this rare defect.
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12
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Ortiz Y, Waldman AJ, Bott JN, Carlan SJ, Madruga M. Blunt Chest Trauma Resulting in Both Atrial and Ventricular Septal Defects. Echocardiography 2014; 32:592-4. [DOI: 10.1111/echo.12801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yahaira Ortiz
- Department of Internal Medicine; Orlando Regional Healthcare; Orlando Florida
| | - Adam J. Waldman
- The Orlando Health Heart Institute; Orlando Regional Healthcare; Orlando Florida
| | - Jeff N. Bott
- The Orlando Health Heart Institute; Orlando Regional Healthcare; Orlando Florida
| | - Steve J. Carlan
- Academic Center; Orlando Regional Healthcare; Orlando Florida
| | - Mario Madruga
- Department of Internal Medicine; Orlando Regional Healthcare; Orlando Florida
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13
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Dedic A, Nieman K, Bogers AJJC, Witsenburg M. Transcatheter closure of a traumatic ventricular septum defect resulting from a stab wound. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 4:96-9. [PMID: 24585940 DOI: 10.1177/2048872613507119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 25-year-old man with a ventricular septal defect resulting from a stab wound to his chest was admitted to our hospital. Because of extensive comorbidity and favourable location, transcatheter closure with an Amplatzer device was preferred over surgical repair. Ventricular septal defects are an uncommon complication of cardiac trauma, but when they do occur from this cause, they often have more dramatic consequences. Transcatheter closure is an attractive, less-invasive alternative in patients with increased surgical risk, multiple previous surgical interventions, or poorly accessible defects.
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Affiliation(s)
- A Dedic
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - K Nieman
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - M Witsenburg
- Erasmus Medical Center, Rotterdam, The Netherlands
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14
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Traumatic ventricular septal defect: characterization with electrocardiogram-gated cardiac computed tomography angiography. J Thorac Imaging 2013; 27:W174-6. [PMID: 23090365 DOI: 10.1097/rti.0b013e31823c3ea5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ventricular septal defects as a result of blunt trauma to the chest have not been frequently reported in the literature. In addition, the majority of these cases have been imaged with echocardiography alone. We report a case in which a ventricular septal defect caused by blunt chest trauma was characterized with electrocardiogram-gated computed tomography angiography. A review of the current literature and theories of injury mechanism are also provided.
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15
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Steed M, Guerra V, Recto MR, Yang SG, Frieberg E, Fox C, Yeh T. Ventricular septal avulsion and ventricular septal defect after blunt trauma. Ann Thorac Surg 2013; 94:1714-6. [PMID: 23098950 DOI: 10.1016/j.athoracsur.2012.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 02/22/2012] [Accepted: 03/05/2012] [Indexed: 10/27/2022]
Abstract
Traumatic ventricular septal defect is an uncommon complication of blunt chest trauma. We report a case of ventricular septal avulsion, associated with traumatic ventricular septal defect and the associated management concerns.
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Affiliation(s)
- Maura Steed
- Department of Surgery, Tulane University, New Orleans, Louisiana; Department of Pediatrics, Tulane University, New Orleans, LA 70112, USA.
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16
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Sugiyama G, Lau C, Tak V, Lee DC, Burack J. Traumatic ventricular septal defect. Ann Thorac Surg 2011; 91:908-10. [PMID: 21353027 DOI: 10.1016/j.athoracsur.2010.08.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 08/21/2010] [Accepted: 08/30/2010] [Indexed: 11/27/2022]
Abstract
Traumatic ventricular septal defect (VSD) is an uncommon occurrence in cases of penetrating cardiac injury with an incidence of only 1% to 5%. The mainstay of diagnosis of VSDs is the transthoracic echocardiogram. We report a case of an occult traumatic VSD, which was not seen on echocardiography, but was later found on a high-resolution computed tomographic scan of the chest.
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Affiliation(s)
- Gainosuke Sugiyama
- State University of New York Downstate Medical Center, Department of Surgery, Division of Cardiothoracic Surgery, Brooklyn, New York, USA
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17
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Stein E, Daigle S, Weiss SJ, Desai ND, Augoustides JGT. CASE 3-2011: successful management of a complicated traumatic ventricular septal defect. J Cardiothorac Vasc Anesth 2011; 25:547-52. [PMID: 21398145 DOI: 10.1053/j.jvca.2011.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Erica Stein
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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18
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Silbiger JJ, Kamran M, Handwerker S, Kumar N, Marcali M. The Gerbode defect: left ventricular to right atrial communication-anatomic, hemodynamic, and echocardiographic features. Echocardiography 2010; 26:993-8. [PMID: 19968690 DOI: 10.1111/j.1540-8175.2009.01009.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jeffrey J Silbiger
- Department of Cardiology, Mount Sinai Services at Elmhurst Hospital Center, Mount Sinai School of Medicine, New York 11373, USA.
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19
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Cheema OM, Patel AA, Chang SM, Shah DJ. Gerbode ventricular septal defect diagnosed at cardiac MR imaging: case report. Radiology 2009; 252:50-2. [PMID: 19561249 DOI: 10.1148/radiol.2521082186] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This report describes the ability of cardiac magnetic resonance (MR) imaging to depict an unusual cardiac defect. A type of ventricular septal defect called the Gerbode defect, which results in a communication between the left ventricle and the right atrium, is presented. To the authors' knowledge, this is the first time cardiac MR imaging has been utilized to characterize this defect.
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Affiliation(s)
- Omar M Cheema
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, 6550 Fannin St, Smith Tower, Suite 677, Houston, TX 77030, USA
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20
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Gandía-Martínez F, Andaluz-Ojeda D, Martínez-Gil I, Campo-Prieto A, Parra-Morais L, Citores-González R. [Interventricular septum rupture following blunt chest trauma]. Med Intensiva 2009; 33:50-3. [PMID: 19232209 DOI: 10.1016/s0210-5691(09)70305-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Interventricular septum rupture following blunt chest trauma is a rare cardiac injury that sometimes is difficult to diagnose. It has a high mortality rate, especially when in cases of hemodynamic instability requiring early surgical repair. We report the case of an 18-year old man who suffered blunt thoracoabdominal trauma and hemorrhagic shock who required emergency abdominal surgery on three occasions. He was diagnosed of traumatic rupture of interventricular septum that had not been detected in the initial echocardiography, but was suspected after the right heart catheterism. Urgent cardiac surgery was performed 72 hours later because of hemodynamic instability.
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21
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Eckart RE, Falta EM, Stewart RW. Complete heart block following penetrating chest trauma in operation Iraqi freedom. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:635-8. [PMID: 18439185 DOI: 10.1111/j.1540-8159.2008.01057.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a 30-year-old US army soldier who had penetrating chest trauma from a road side explosive with focal cardiac injury. The soldier had penetration of his right atrium and subsequent traumatic membranous ventricular septal defect and complete heart block. He was brought to a Combat Support Hospital where fortuitously the assigned trauma surgeon on-call was a cardiothoracic surgeon, and the assigned trauma intensivist on-call was a cardiac electrophysiologist. Of course, the only source they knew of a pacemaker was halfway around the world. We discuss the management of this injury in an austere combat environment.
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Affiliation(s)
- Robert E Eckart
- 28th Combat Support Hospital, Task Force North, Ibn Sina Hospital, Baghdad, Iraq.
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22
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23
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Uslu N, Kayacioglu I, Ates M, Eren M. 'Acquired' left ventricular to right atrial shunt after mitral valve replacement: detection by transthoracic colour Doppler echocardiography. Can J Cardiol 2007; 23:735-6. [PMID: 17622397 PMCID: PMC2651918 DOI: 10.1016/s0828-282x(07)70819-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Left ventricular to right atrial communications are rare types of ventricular septal defects usually of congenital origin. A case of an iatrogenic shunt between the left ventricle and the right atrium as a rare complication of mitral valve replacement is reported.
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Affiliation(s)
- Nevzat Uslu
- Cardiology Department, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
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24
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Abstract
Left ventricle to right atrial communications, collectively known as Gerbode defects, are usually congenital defects and surgical closure remains the treatment of choice. We report a rare case of Gerbode defect acquired following surgical closure of a ventricular septal defect. The defect was successfully closed percutaneously with an Amplatzer ventricular septal occluder. The patient remained symptom free with optimal result on echo at 6 months of follow-up. This is the first reported case of successful device closure of an acquired Gerbode defect.
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Affiliation(s)
- Vijay Trehan
- Department of Cardiology, GB Pant Hospital, New Delhi, India
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25
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Rollins MD, Koehler RP, Stevens MH, Walsh KJ, Doty DB, Price RS, Allen TL. Traumatic Ventricular Septal Defect: Case Report and Review of the English Literature since 1970. ACTA ACUST UNITED AC 2005; 58:175-80. [PMID: 15674170 DOI: 10.1097/01.ta.0000066147.57530.2e] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michael D Rollins
- Department of Surgery, LDS Hospital, Salt Lake City, Utah 84143, USA
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26
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Abstract
Chest pain is common in adolescents and in young adults and usually not associated with a severe underlying cardiovascular disorder. However, in adults with congenital heart disease, residua or sequellae of previous interventions may provoke potential complications. Moreover, chest pain may be the first sign of a life-threatening condition. Basic knowledge is mandatory and will lead to the correct diagnosis and treatment. Data in literature, which focus on this issue, are scarce and motivated to summarize the experience of daily practice from the eye point of the clinician.
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27
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Pesenti-Rossi D, Godart F, Dubar A, Rey C. Transcatheter closure of traumatic ventricular septal defect: an alternative to surgery. Chest 2003; 123:2144-5. [PMID: 12796201 DOI: 10.1378/chest.123.6.2144] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The incidence of ventricular septal defect (VSD) occurs in up to 4.5% of penetrating cardiac trauma. We report a patient with persistent VSD who underwent surgical repair with significant left-to-right shunt and signs of heart failure. We performed a successful transcatheter closure of the VSD with an Amplatzer septal occluder (AGA Medical Corporation; Golden Valley, MN).
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Affiliation(s)
- David Pesenti-Rossi
- Departments of Pediatric Cardiology, Cardiac Hospital, University of Lille, Lille, France
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28
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Abstract
Cardiac injuries caused by a heart traumatism are not frequent but, of great importance given their high morbidity. Two different groups in terms of etiology, clinical picture, application of diagnostic techniques, treatment and prognosis can be considered. On one hand, there are cardiac injuries caused by a thoracal contusion, which provokes a contused lesion can affect the free wall, the interventricular septum, the valves, the subvalvular apparatus, the conduction system and the coronary vessels and, on the other hand, cardiac injuries caused by penetrating objects. Cardiac injury can lead to a life-threatening hemodynamic instability which mandates prompt and clear diagnostic and therapeutic approaches.
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Affiliation(s)
- J R Echevarría
- Servicios de Cirugía Cardíaca y Cardiología, ICICOR, Hospital Universitario, Valladolid
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Tĕsínský L, Pirk J, al-Hiti H, Málek I. An isolated ventricular septal defect as a consequence of penetrating injury to the heart. Eur J Cardiothorac Surg 1999; 15:221-3. [PMID: 10219561 DOI: 10.1016/s1010-7940(98)00297-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The authors describe, in a case report, an isolated defect of the ventricular septum developing due to a stab injury to the heart not requiring an emergency surgical intervention. Two months after the injury, the authors performed primary surgical correction of the defect.
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Affiliation(s)
- L Tĕsínský
- Department of Cardiovascular and Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Pasteuning WH, Wonnink-de Jonge WF, van Berge Henegouwen DP, van der Aa MA, Penn OC. Acquired ventricular septal defect and mitral insufficiency without pericardial effusion after stab wound to the chest. J Am Soc Echocardiogr 1998; 11:483-6. [PMID: 9619622 DOI: 10.1016/s0894-7317(98)70030-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Echocardiography has a role in the management of acute complications of penetrating cardiac trauma. We report the case of a 30-year-old man who sustained a stab wound to the chest. In this case a traumatic perforation of the ventricular septum and the anterior leaflet of the mitral valve caused by a knife occurred without pericardial effusion. The diagnosis was made by transthoracic echocardiography. The ability of transesophageal echocardiography to delineate the intracardiac injuries more precisely helped to guide the surgical procedure.
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Affiliation(s)
- W H Pasteuning
- Department of Cardiology, Sint Elisabeth Ziekenhuis, Tilburg, The Netherlands
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D'Cruz IA, Calderon E, Shearin S, Pitts J. Acquired Ventricular Septal Defect Following Stab Wound Color Flow Doppler Diagnosis. Echocardiography 1997; 14:409-410. [PMID: 11174975 DOI: 10.1111/j.1540-8175.1997.tb00743.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ivan A. D'Cruz
- Cardiology Section, VA Medical Center, 1030 Jefferson Avenue, Memphis, TN 38104
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Abstract
In cardiac trauma the two main mechanisms of injury are blunt and penetrating trauma. Common cardiac effects of trauma include myocardial rupture, contusion, laceration, pericardial insult, coronary injury, valvular damage, arrhythmias, and conduction abnormalities. Hemodynamic instability can develop rapidly and pose marked risk to patient survival. An adequate level of clinical awareness and timely use of diagnostic techniques such as echocardiography, aortography, and cardiac angiography are essential for rapid identification of cardiac trauma. Once the diagnosis is made, prompt surgical intervention is often the key to survival.
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Affiliation(s)
- M R Olsovsky
- Division of Cardiology, Medical College of Virginia, Virginia Commonwealth University, McGuire VA Medical Center, Richmond, USA
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