title: Transcatheter closure of a traumatic ventricular septal defect using an Amplatzer™ atrial septal occluder device.
abstract: A relatively rare occurrence, the incidence of ventricular septal defect (VSD) complicating penetrating cardiac trauma has been reported at 4.5%. Closing such defects may be challenging especially in an unstable patient where cardiopulmonary bypass may exponentially increase the surgical risk. In such patients, catheter-based device closure is a reliable and effective alternative. We describe case of a 30 year old man who presented with a stab wound to his anterior mediastinum. His injuries involved laceration to right and left ventricles and a VSD. His lacerations were repaired on a beating heart and the VSD was not addressed due to patient hemodynamic instability. The VSD was semi-electively closed using a 24 mm Amplatzer™ device as the patient demonstrated significant left to right shunt. Post-device closure, the patient developed hemolysis attributed to an intra- device residual leak. The hemolysis resolved without any complications by conservative medical management. At latest follow-up the patient is in NYHA functional class I-II.
authors.affiliation: Department of Surgery, The Aga Khan University Hospital, Stadium Road, Karachi.
authors.forename: Taimur A
authors.initials: TA
authors.lastname: Ali
authors.forename: Saulat H
authors.initials: SH
authors.lastname: Fatimi
authors.forename: Babar S
authors.initials: BS
authors.lastname: Hasan
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D006335:Heart Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006461:Hemolysis; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D055989:Septal Occluder Device; D016896:Treatment Outcome; D054088:Ventricular Septum / Q000293:injuries* / Q000503:physiopathology; D014951:Wounds, Stab / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
keywords: acquired intracardiac defect; device closure