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Year : 2016  |  Volume : 1  |  Issue : 1  |  Page : 23-28

Ventricular septal defect from blunt cardiac injury: A case report and meta-analysis of 64 patients from 61 reviews

1 Atlanta Medical Center, Atlanta, GA, Nigeria
2 Dr. Joe Nwiloh Heart Center, St. Joseph's Hospital, Adazi-Nnukwu, Anambra State, Nigeria

Correspondence Address:
Jonathan Nwiloh
Dr. Joe Nwiloh Heart Center, St. Joseph's Hospital,Adazi Nnukwu, Anambra State
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Source of Support: None, Conflict of Interest: None

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A 36-year-old male motorcyclist involved in a motor vehicle accident (MVA) with loss of consciousness and sustained multiple orthopedic injuries and a traumatic ventricular septal defect (VSD) which was hemodynamically stable. He then underwent emergency orthopedic surgery and was discharged after 5 weeks to rehabilitation. Subsequently, 6 months later, he underwent an elective repair of a 1.5 cm apical septal defect with uneventful recovery. A meta-analysis of 61 other reports of traumatic VSD revealed MVA as the most common etiology in 57.8%, predominantly males in 85.5% and younger age group <30 years in 87.5%. The midmuscular septum was involved in 43.6%, and patch closure was used in the majority of patients performed through a right or left ventriculotomy. Operative mortality was zero with elective versus 27.3% for emergency repairs, which also had a 27.3% VSD recurrence. 28.6% of the patients required concomitant cardiac surgical procedures while two patients (4.1%) both with perimembranous VSD required a permanent pacemaker. Less invasive transcatheter closure was successfully deployed in three patients without any complications, and it is an alternative in patients with a suitable anatomy and no associated cardiac injuries requiring surgery. Conservative therapy as a mainstay of treatment should be reserved for asymptomatic small defects with hemodynamically insignificant shunts.

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