Traumatic ventricular septal defect following a stab wound to the chest.
A 51-year-old man who had been suffering from depression stabbed himself in the chest with an ice pick. At presentation, an ice pick lodged in the left fifth intercostal space was moving synchronously with his heartbeat. Echocardiography revealed that the tip was penetrating the anterior wall of the right ventricle. Because the patient was tamponading, an emergency operation was carried out. The ice pick was removed following the establishment of a cardiopulmonary bypass and pericardiotomy. The perforation of the right ventricle was closed with a pledget-reinforced mattress stitch. On postoperative day 12, a holosystolic murmur was detected on auscultation. Transthoracic echocardiography revealed a ventricular septal defect 5 mm in diameter located near the apex. The pulmonary-tosystemic flow ratio was 1.1 by echocardiographic measurement. No sign of heart failure was present. Although it was agreed to manage the ventricular septal defect conservatively, careful echocardiographic follow-up is mandatory.
Ito
Hideki
H
Division of Cardiovascular Surgery, Aichi Cardiovascular and Respiratory Center, 2135 Kariyasuka, Yamato-cho, Ichinomiya, Aichi 491-0934, Japan. sinngehide@yahoo.co.jp
Saito
Shunei
S
Miyahara
Ken
K
Takemura
Haruki
H
Sawaki
Sadanari
S
Matsuura
Akio
A
D002305:Cardiac Tamponade / Q000209:etiology; D002315:Cardiopulmonary Bypass; D003863:Depression / Q000523:psychology; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy; D013406:Suicide, Attempted; D013536:Suture Techniques; D016896:Treatment Outcome; D014463:Ultrasonography; D054088:Ventricular Septum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014951:Wounds, Stab / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery