Traumatic ventricular septal defect following closed-chest massage: a new approach to closure

A 59-year-old man underwent a quadruple coronary bypass. Nine hours postoperatively, cardiac arrest developed; it was preceded by bradycardia resistant to pacing. Closed-chest massage resulted in a rapid recovery of stable cardiac function followed by the development of cardiogenic shock. A new systolic murmur was appreciated 36 hours following arrest. It was diagnosed at catheterization as a ventricular septal defect that was subsequently found to lie in the posterior ventricular septum, and two operations were necessary to effect closure. The final operation was performed with exposure of the septal defect through the right atrium. Sixteen months after operation, the patient remained well. To our knowledge, this is the first reported instance of a ventricular septal defect occurring secondary to closed-chest massage and also of the closure of a traumatic defect using a right atrial approach.