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Published on: February 8, 2022
Transcatheter closure of traumatic ventricular septal defect: an alternative to surgical repair?
Alain Fraisse1, Jean-François Piéchaud, Jean-François Aviérinos
1Service de Cardiologie, Hôpital de la Timone, Marseille, France. afraisse@mail.ap-hm.fr
Insights
Transcatheter closure of traumatic ventricular septal defects offers an alternative to surgery but carries significant risks. This procedure, while technically successful, did not prevent a fatal outcome in a patient with severe head trauma.
Area of Science:
- Cardiology
- Trauma Surgery
- Interventional Cardiology
Background:
- A 19-year-old male presented with multisystem trauma, including severe head injury and two traumatic ventricular septal defects (VSDs).
- Surgical repair of the VSDs was contraindicated due to the high risk of intracranial bleeding associated with necessary anticoagulation for cardiopulmonary bypass.
Observation:
- Transcatheter closure using Amplatzer devices was pursued as a less invasive alternative to surgical intervention.
- The procedure aimed to address the hemodynamically significant VSDs without requiring cardiopulmonary bypass.
Findings:
- Successful transcatheter closure of both traumatic ventricular septal defects was achieved.
- Despite successful device deployment, the patient remained hemodynamically unstable post-procedure.
Implications:
- Transcatheter closure of traumatic VSDs is a viable alternative to surgical repair in specific high-risk scenarios.
- The procedure is associated with significant risks and necessitates expert anesthesia management for optimal outcomes.
- This case highlights the complex management challenges and potential limitations of transcatheter VSD closure in critically ill trauma patients.
Abstract:
A 19-year-old man with multiple-system injuries including a serious head injury and two poorly tolerated traumatic ventricular septal defects, was admitted to our hospital. Transcatheter closure of the cardiac defects was attempted instead of surgical repair because the required anticoagulation for cardiopulmonary bypass could precipitate intracranial bleeding. The two ventricular septal defects were successfully closed with Amplatzer devices, but the patient remained in hemodynamically unstable condition and subsequently died. Transcatheter closure of traumatic ventricular septal defect is an alternative to surgical repair, although it remains a hazardous procedure and requires experienced anesthesia management.
