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Ruptured interventricular septum after blunt chest trauma: ultrasonographic diagnosis
Y Harel1, A Szeinberg, W A Scott
1Pediatric Critical Care Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
A child sustained severe chest trauma from a bookcase, developing a ventricular septal defect and atrioventricular block. Despite surgical repair and a pacemaker, she experienced cardiogenic shock and expired, highlighting the critical nature of such injuries.
Area of Science:
- Pediatric Cardiology
- Trauma Surgery
- Critical Care Medicine
Background:
- Chest trauma in children can lead to complex cardiac injuries.
- Early recognition and intervention are crucial for managing pediatric trauma patients.
Observation:
- A 6-year-old presented with dyspnea, systolic murmur, and complete atrioventricular (A-V) block after chest compression.
- Echocardiography revealed a large ventricular septal defect and tricuspid insufficiency.
Findings:
- Surgical repair of the septal defect and tricuspid valve was performed, along with pacemaker insertion.
- Despite initial improvement, the patient developed refractory cardiogenic shock and right ventricular dysfunction, leading to expiration.
Implications:
- This case underscores the severe cardiac sequelae of blunt chest trauma in pediatric patients.
- Management requires a multidisciplinary approach, including advanced cardiac support and surgical intervention.
- Further research into pediatric chest trauma outcomes is warranted.
Abstract:
A 6-year-old child was found under a heavy bookcase that compressed her chest. On admission to the emergency room she was found to be dyspneic with a systolic murmur and complete atrioventricular (A-V) block. Her condition deteriorated rapidly, leading to cardiogenic shock and loss of consciousness. Echocardiographic Doppler evaluation demonstrated a large ventricular septal defect and tricuspid insufficiency. A pericardial patch was put over the tear in the septum, and torn chordae tendinae were reimplanted to the papillary muscles. A pacemaker was inserted. Her situation improved, but on the third day cardiogenic shock and right ventricular dysfunction ensued and the patient expired. A review of the previous 13 cases from the pediatric literature is presented.