title: Delayed detection of a ventricular septal defect following penetrating trauma.
abstract: This is a case report of a 27-year-old male who sustained a stab wound to the chest with a resulting penetrating cardiac injury and subsequent emergency thoracotomy. The patient survived his injury and on post-op day two, a holosystolic murmur was noted during physical exam, but he remained hemodynamically stable and intubated. A transthoracic echocardiogram revealed the presence of a ventricular septal defect (VSD), with Doppler flow revealing shunting from the left ventricular cavity into the right ventricular cavity. Ultimately, the clinicians decided upon a trial of extubation with a plan for delayed closure of the VSD. Upon extubation,the patient became hypoxemic with evidence of pulmonary edema; thus, he was re-intubated. The defect was surgically repaired, and the patient had an uneventful recovery thereafter. The purpose of this case report is to present an example of delayed detection of a ventricular septal defect after a penetrating cardiac injury.
authors.affiliation: Assistant Professor in Louisiana State University Health Sciences Center's School of Medicine and the Program Director of the LSUHSC's Emergency Medicine Residency Program in Baton Rouge.
authors.forename: Terrell
authors.initials: T
authors.lastname: Caffery
authors.affiliation: Dr Robinson completed his residency at LSUHSC's Emergency Medicine Residency Program in Baton Rouge, and he is currently an Emergency Medicine Physician at St. Tammany Parish Hospital.
authors.forename: Danny
authors.initials: D
authors.lastname: Robinson
authors.affiliation: Assistant Professor of Clinical Medicine, Pulmonary and Critical Care Medicine, LSU Health Science Center, Baton Rouge.
authors.forename: Hollis
authors.initials: H
authors.lastname: O'Neal
authors.affiliation: Assistant Professor of Surgery in the CVT Surgical Center at the LSUHSC in New Orleans.
authors.forename: Azheem
authors.initials: A
authors.lastname: Kahn
authors.affiliation: Assistant Professor of Surgery in the CVT Surgical Center at the LSUHSC in New Orleans.
authors.forename: Scott
authors.initials: S
authors.lastname: Thurston
authors.affiliation: Academic Research Director for LSUHSC's Emergency Medicine Residency Program in Baton Rouge.
authors.forename: Mandi
authors.initials: M
authors.lastname: Musso
mesh_terms: D000328:Adult; D004452:Echocardiography; D006335:Heart Injuries / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D013908:Thoracotomy; D016896:Treatment Outcome; D014951:Wounds, Stab / Q000601:surgery*