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IMAGES IN CARDIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Heart 2005;91:e41 (http://www.heartjnl.com/cgi/content/full/91/5/e41). doi: 10.1136/hrt.2004.055152
Traumatic ventricular septal defect and tricuspid regurgitation
A
32 year male patient presented
with complaints of chest pain and
dyspnoea on exertion. He had
sustained blunt trauma to the anterior
chest wall after falling down from a
motorcycle 3 years earlier. There was a
systolic murmur during his initial evaluation after the accident. However, the
patient refrained from undergoing
further investigations. During the past
3 months he developed recurrent episodes of paroxysmal palpitations and his
symptoms worsened. On clinical examination the pulse was 86 beats per
minute, blood pressure was 130/76 mm
Hg, and jugular venous pressure was
elevated and showed prominent V
waves with accentuated Y descent. The
precordium revealed prominent pulsations with a systolic thrill. He was found
to have a 4/6 harsh systolic murmur
radiating across the sternum.
Chest x ray showed cardiomegaly
(cardiothoracic ratio of 0.62) with right
atrial enlargement and evidence of
increased pulmonary blood flow.
Electrocardiogram showed right bundle
branch block with right axis deviation.
Echocardiographic examination showed
a ventricular septal defect in the perimembranous location with ragged
margins. Anterior tricuspid leaflet was
prolapsing with non-coaptation causing severe tricuspid incompetence
with a regurgitant velocity of 2.8 M/s.
Cardiac catheterisation revealed elevated right atrial pressures (RA mean
16 mmHg with tall v waves of 24–
26 mm Hg), mild pulmonary arterial
hypertension,andmildpulmonaryvenous
(A) Transoesophageal echocardiogram showing the ventricular septal defect with its ragged margin
(arrow). (B) Transoesophageal echocardiogram showing the prolapsing tricuspid valve leaflet
(arrow). (C) Transthoracic echocardiogram showing patch repair (arrow) of the ventricular septal
defect. (D) Transthoracic echocardiogram showing repaired tricuspid valve. LA, left atrium; LV, left
ventricle; RA, right atrium; RV, right ventricle.
hypertension. The ratio of left to right
shunt was 5.35:1. Angiocardiogram in
the left anterior oblique view with
cranial tilt showed a perimembranous
ventricular septal defect (VSD).
He underwent surgery, during which
an interooperative transoesophageal
echocardiogram confirmed the preoperative findings (panels A and B). At
surgery there was a 2 cm62 cm perimembranous VSD with bifid muscular
septum and redundant tricuspid leaflet
prolapsing near the anteroseptal commissure. The VSD was closed with a
Dacron patch through the right atrial
approach and primary repair of the
tricuspid valve was done. At follow
up after 1 month the patient was
asymptomatic.
S Kothari
S Anandaraja
B Airan
[email protected]
www.heartjnl.com
Downloaded from http://heart.bmj.com/ on May 3, 2017 - Published by group.bmj.com
Traumatic ventricular septal defect and
tricuspid regurgitation
S Kothari, S Anandaraja and B Airan
Heart 2005 91: e41
doi: 10.1136/hrt.2004.055152
Updated information and services can be found at:
http://heart.bmj.com/content/91/5/e41
These include:
Supplementary Supplementary material can be found at:
Material http://heart.bmj.com/content/suppl/2005/04/25/91.5.e41.DC1
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