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Eur J Cardiothorac Surg 2007;31:949-951. doi:10.1016/j.ejcts.2007.01.068
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Case reports

Traumatic free wall and ventricular septal rupture — ‘hybrid’ management in a child

^a Division of Congenital Cardiac Surgery, Children's Hospital, University Zurich, Switzerland
^b Department of Cardiology, Children's Hospital, University Zurich, Switzerland

Received 10 September 2006; received in revised form 19 January 2007; accepted 23 January 2007.

^_* Corresponding author. Address: Division of Congenital Cardiac Surgery, Children's Hospital, University Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland. Tel.: +41 1 266 8020; fax: +41 1 266 8021. (Email: a.kadner{at}web.de).

A 8-year-old boy showed a traumatic ventricular septal rupture following a blunt chest trauma, and was scheduled for elective catheter closure. Two weeks later, a follow-up echocardiogram revealed a pseudoaneurysm of the anterior wall of the left ventricle. Because of the apical location of the VSD, it was decided to proceed with transcatheter occlusion. After successful VSD closure, the patient was taken to the operation room for surgical repair of the left ventricular pseudoaneurysm. Symptoms and signs seen in patients with ventricular pseudoaneurysms appear to be discrete and variable, and a high clinical index of suspicion with a very close echocardiographic follow-up is strongly recommended after occurrence of a blunt cardiac trauma. The combined ‘hybrid’ approach of transcatheter closure of the intraventricular rupture followed by surgical closure of the pseudoaneurysm allows for a less invasive and efficient management of this rare combination of post-traumatic ventricular free wall and septal rupture in a child.

Key Words: Pseudoaneurysm • Traumatic VSD • Chest trauma • Hybrid therapy