A young adult pedestrian was admitted to hospital after being hit by a car.On arrival to the Accident and Emergency Department, the patient was tachycardic, hypotensive, hypoxic, red pygmy dogwood and acidotic with a Glasgow Coma Scale of 3.Despite initial interventions, the patient remained persistently hypotensive.
An echocardiogram demonstrated a traumatic ventricular septal defect (VSD) with right ventricular strain and increased pulmonary artery pressure.Following a period of stabilization, open cardiothoracic surgery was performed and revealed an aneurysmal septum with a single large defect.This was repaired with a bovine patch, resulting in normalization of right ventricular function.
This case provides a vivid depiction of a large diet frostie root beer VSD in a patient following blunt chest trauma with hemodynamic compromise.In all thoracic trauma patients, and particularly those poorly responsive to resuscitation, VSDs should be considered.Relevant investigations and management strategies are discussed.