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| INVITED COMMENTARY |
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| Year : 2016 | Volume
: 1
| Issue : 1 | Page : 29-30 |
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Management options for ventricular septal defect from blunt cardiac injury
Leo C Egbujiobi
The Hendricks Family Hospital, Beloit Health System, Beloit, Wisconsin, United States
| Date of Web Publication | 25-Jul-2016 |
Correspondence Address:
Leo C Egbujiobi
The Hendricks Family Hospital, Beloit Health System, Beloit, Wisconsin
United States
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Egbujiobi LC. Management options for ventricular septal defect from blunt cardiac injury. Niger J Cardiovasc Thorac Surg 2016;1:29-30 |
Dr. Nwiloh et al. [1] deserve tremendous praise for this superb case presentation on ventricular septal defect (VSD) due to blunt cardiac injury (BCI) and for undertaking the tedious work on its review and meta-analysis.
Since the 1988 report by Lock et al. [2] on the percutaneous closure of VSD in six patients, there continues to be accelerated interest in the role of catheter-based therapies in one of the most commonly recognized congenital heart defects, VSD (approximately 2 in 1000 deaths). [2],[3] Due to the increasing awareness of VSDs, many are assessed and recognized at birth. However, posttraumatic VSDs are more challenging and are often difficult to recognize.
Following injury, approximately 80% of patients suffering penetrating cardiac injuries die before reaching the hospital, while only 8-19% of those who made it to the hospital survived. [4],[5] Blunt trauma cardiac injury VSD occurs in 5.5% of those who did not die immediately. [5]
Previously, open-heart surgical intervention has been the continued and mainstay treatment option for posttraumatic VSDs. However, percutaneous closure of newly diagnosed traumatic-induced heart defects continue to arise due to the accumulative knowledge and practiced techniques of transcatheter therapeutics; this continues to make this particular surgical option increasingly offered. [5],[6]
Currently, multiple devices are available (or in development) for the closure of these defects including the Amplatzer VSD.
Occluder device (AGA Medical Corporation, Golden Valley, MN, USA) which centers and fills the VSD using a double-disc expandable wire mesh material and the patent ductus arteriosus occluder (Lifetech Scientific [Shenzhen] Co., Ltd., Guangdong, China) which acts to prevent emboli and promote occlusion by using its single-disc cone shape to position within the ductus itself. These two devices are currently the most utilized approaches with respectable results [Figure 1]. | Figure 1: (a) Patent ductus arteriosus occluder (Lifetech Scientific [Shenzhen] Co., Ltd., Guangdong, China); (b) Amplatzer ventricular septal defect Occluder device (AGA Medical Corporation, Golden Valley, MN, USA). Source: Bioassist. St. Jude, 2015. Web. 13 July 2016
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Nwiloh et al. [1] observations and recommendations are apt and should be appreciated by providers working in this field.
We agree a thorough and rapid assessment of the patient with attention to history and physical are essential, that surgery should be considered the initial treatment for a majority of these patients since they present with other surgical needs. However, if observation of the VSD is initially felt appropriate, the bar for percutaneous closure should be lowered since the mortality of those managed conservatively approached 25-27%.
With attention to a thorough history and physical exam, Transthoracic echocardiogram/transesophageal echocardiography, and radiologic imaging aiding in the diagnosis of VSD post-BCI, I believe percutaneous closure may be considered ideal for most patients since the defect tends to occur strictly within the muscular membrane. As innovations and research continue to expand and develop in the percutaneous intervention world, I see catheter-based therapy the preferred option to close VSDs regardless of the etiology.
| References | |  |
| 1. | Nwiloh J, Orakwe O, Etukokwu K, Okechukwu U, Iziga N, Onyenwuzor C. Ventricular septal defect from blunt cardiac injury: A case report and meta-analysis of 64 patients from 61 reviews. Niger J Cardiovasc Thorac Surg 2016;1:23-8.   |
| 2. | Lock JE, Block PC, McKay RG, Baim DS, Keane JF. Transcatheter closure of ventricular septal defects. Circulation 1988;78:361-8. |
| 3. | Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births. Incidence and natural history. Circulation 1971;43:323-32. |
| 4. | Sugg WL, Rea WJ, Ecker RR, Webb WR, Rose EF, Shaw RR. Penetrating wounds of the heart. An analysis of 459 cases. J Thorac Cardiovasc Surg 1968;56:531-45. |
| 5. | Dehghani P, Ibrahim R, Collins N, Latter D, Cheema AN, Chisholm RJ. Post-traumatic ventricular septal defects - Review of the literature and a novel technique for percutaneous closure. J Invasive Cardiol 2009;21:483-7. |
| 6. | Xi EP, Zhu J, Zhu SB, Yin GL, Liu Y, Dong YQ, et al. Percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder. Clinics (Sao Paulo) 2012;67:1281-3. |
[Figure 1]
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