Cardiac Injury Causing Traumatic Ventricular Septal Rupture With Right Ventricular Pseudoaneurysm

Ventricular septal rupture (VSR) is a rare, potentially fatal consequence of blunt cardiac injury (BCI). Concomitant right ventricular (RV) pseudoaneurysm formation is even rarer, and the occurrence of both complications has not to our knowledge been previously reported.

A 63-year-old man presented with a VSR and a torn tricuspid chord, flail leaflet, and severe tricuspid regurgitation after BCI due to a motor vehicle accident. He declined surgery initially and presented a month later with severe heart failure symptoms. Imaging at that time demonstrated a persistent VSR and a new RV pseudoaneurysm. His condition was not deemed to be amenable to percutaneous closure, and he again declined open surgical repair.

VSR after BCI results from acute mechanical forces and/or delayed necrosis, with RV pseudoaneurysm developing as a delayed complication likely due to inflammatory necrosis. Multimodality imaging provides comprehensive anatomical assessment and tissue characterization and guides accurate diagnosis, prognostication, and therapeutic planning.

This case emphasizes the importance of early recognition and the value of serial imaging in blunt cardiac trauma, with surgical repair recommended for significant defects and management tailored to the anatomy, timing of complications, and patient preferences.