title: Traumatic ventricular septal rupture associated with rapid progression of heart failure despite low Qp/Qs ratio: a case report.
abstract: BACKGROUND
  Ventricular septal rupture (VSR) secondary to blunt chest trauma is rare and associated with a diverse range of symptoms and clinical courses as well as disease severity. We present a case of traumatic VSR in which rapid progression of heart failure was observed in spite of relatively low pulmonary to systemic blood flow (Qp/Qs) ratio.
  
  
  METHODS
  A 40-year-old male was transported to the emergency department approximately 12 h after blunt chest trauma. VSR was diagnosed by echocardiography, and right heart catheterization revealed a Qp/Qs ratio of 1.52. Although medical treatment was initially attempted, subsequent rapid progression of heart failure necessitated emergent surgical repair of VSR.
  
  
  CONCLUSIONS
  Because small, asymptomatic VSR often close spontaneously, surgical repair of traumatic VSR is indicated when the shunt rate is relatively large or heart failure is present. However, the present case highlights the need to consider emergent surgical repair of traumatic VSR, even when the shunt rate is relatively small.
authors.affiliation: Department of Medicine II, Kansai Medical University, Hirakata, Japan. murakako@hirakata.kmu.ac.jp.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Murakawa
authors.affiliation: Department of Medicine II, Kansai Medical University, Hirakata, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Kansai Medical University, Hirakata, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Okada
authors.affiliation: Department of Medicine II, Kansai Medical University, Hirakata, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Toyoshima
authors.affiliation: Department of Cardiology, Rakusai New Town Hospital, Kyoto, Japan.
authors.forename: Reisuke
authors.initials: R
authors.lastname: Yuyama
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Kansai Medical University, Hirakata, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Minato
authors.affiliation: Department of Medicine II, Kansai Medical University, Hirakata, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Shiojima
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D018658:Ventricular Septal Rupture / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000150:complications
keywords: Blunt chest trauma; Early mechanical rupture; Emergency surgical closure; Low shunt rate; Ventricular septal rupture