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Lopez-Marco et al. Vessel Plus 2018;2:40 Vessel Plus
DOI: 10.20517/2574-1209.2018.67

Case Report Open Access

Ventricular septal defect and tricuspid and mitral
valve insufficiency caused by penetrating trauma

Ana Lopez-Marco , Jennifer Williams , Christine Tan , Dheeraj Mehta 1
1
1
2
1 Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff CF14 4XW, UK.
2 Department of Anaesthesia, University Hospital of Wales, Cardiff CF14 4XW, UK.

Correspondence to: Dr. Ana Lopez-Marco, Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff CF14
4XW, UK. E-mail: analopez1000@hotmail.com
How to cite this article: Lopez-Marco A, Williams J, Tan C, Mehta D. Ventricular septal defect and tricuspid and mitral valve
insufficiency caused by penetrating trauma. Vessel Plus 2018;2:40. http://dx.doi.org/10.20517/2574-1209.2018.67
Received: 2 Oct 2018 First Decision: 16 Oct 2018 Revised: 17 Oct 2018 Accepted: 18 Oct 2018 Published: 5 Dec 2018

Science Editor: Mario F. L. Gaudino Copy Editor: Cui Yu Production Editor: Zhong-Yu Guo

Abstract
A 28-year old male sustaining a penetrating injury to the subxiphoid area presented to the emergency department
fully conscious and haemodynamically stable. The CT scan revealed a localized infero-posterior pericardial
collection. Emergency surgery was planned to evacuate the collection and assess the extent of injury. Intraoperative
transoesophageal echocardiogram demonstrated severe tricuspid regurgitation due to transection of the papillary
muscle, as well as a ventricular septal defect. Tricuspid repair with reconstruction of the papillary muscle, closure of the
ventricular septal defect (VSD) and the right ventricular laceration was performed. Mitral regurgitation secondary to
chordae rupture was identified following de-airing maneuvers, and subsequently underwent repair. Traumatic VSD and
lesions of the mitral and tricuspid valves causing insufficiency have been reported before. They have been described in
isolation or as combination of two lesions but never the combination of the three of them as described in this case.

Keywords: Cardiac trauma, penetrating wounds, emergency, ventricular septal defect, heart valve disease, transoesophageal
echocardiography

INTRODUCTION
Penetrating cardiac injuries are usually secondary to stab or gunshot wounds. They represent a life
threatening condition that often requires emergency surgery for evacuation of the commonly associated
[1,5]
[1-6]
cardiac tamponade . The free ventricular walls, especially on the right side are more commonly affected .
Injury of the cardiac valves and intraventricular septum is rare but it has been described, although more
[1-6]
frequently associated with blunt cardiac trauma .
© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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