2009 Southern Regional Meeting Abstracts

Purpose of Study: To investigate a case of traumatic ventricular tear
Methods Used: Case study
Summary of Results: A previously healthy 6 year-old male was seen at a referring hospital following a motor vehicle accident. The child was unrestrained in the back seat. He lost consciousness immediately, but was awake and alert on addmission. On arrival, he was pale, bradycardic, hypotensive and had multiple abrasions and lacerations. Blood pressure was 79/32, heart rate was 49 bpm with faint radial pulses. Cardiac exam was unremarkable with a quiet precordium, normal S1 and S2 and no murmurs or clicks. An electrocardiogram demonstrated complete (third-degree) AV block, left bundle branch block, and an episode of non-sustained ventricular tachycardia. A temporary transvenous pacing catheter was inserted. An echocardiogram was performed at the bedside which showed a ventricular septal tear with no evidence of left to right shunting and basilar inferior wall dyskinesis with overall good left ventricular function. Intravenous Milrinone gtt at 1 mcg/kg/min was begun due to the patient’s increased susceptibility to arrhythmias, particularly ventricular tachycardia. Due to risk of ventricular septal rupture, the child was transferred to another hospital where a pediatric cardiothoracic surgeon was available. There the patient’s other injuries were further stabilized and cardiac function was closely observed. No further treatment was required for his ventricular septal tear or AV block. 24 days after the accident, the child was seen for cardiac follow-up where EKG continued to demonstrate left bundle branch block, however, he was now in first-degree heart block instead of third-degree. Echocardiogram remained unchanged.
Conclusions: Cardiac injuries are a common result of blunt chest trauma acquired during high-speed motor vehicle accidents. In rare cases, ventricular septal tear may occur.Echocardiography is the best diagnostic modality for identifying this abnormality.Close monitoring and follow-up is required as hypotension, arrhythmia, and septal rupture are possible complications