Surgical correction of posttraumatic VSD via the right atrium

We report the cases of four patients seen with ventricular septal defects (VSDs) resulting from penetrating chest trauma; initial surgical management was via left thoracotomy and comprised relief of tamponade and suture of the surface cardiac wound. A VSD was suspected in all four patients postoperatively on the basis of a holosystolic murmur as confirmed with two-dimensional echo and angiography. Elective surgical repair was undertaken on cardiopulmonary bypass with bicaval cannulation and cardioplegic arrest. The interventricular septum was approached through the right atrium (no attempt was made to free the anterior surface of the right ventricle from adhesions). Three defects were closed directly and one was closed with a pericardial patch. The surgical correction of posttraumatic VSD from a penetrating injury can be safely and effectively achieved via a right atrial approach.