Ventricular Septal Rupture as Complication of Acute Miocard Infarct in Adolescent Caused by Blunt Chest Trauma: A Case Report
Author : F.M. Yusuf, S. Khairunnissa, M.F Rizky, M.N.Aditya, P.L.T. Mangiring
Upload Date : 19-04-2018
Introduction: Ventricular septal rupture(VSR) is a mechanical complication of post acute miocard infarction(AMI) with incidence rate around 2.3%. VSR caused by AMI due to blunt chest trauma is a rare occurence with incidence rate of remains unknown.
Case Description: A 16 year-old male presented to Emergency Department (ED) with typical angina and short of breathness, PND(+), oedema (-) since 2 days after a motor cycle injury whereas his chest hit by handlebar. There is no coronary risk factor or history of congenital heart disease. Physical examination showed BP 80/60 mmHg, HR 130 bpm, RR 26x/m, rhales ¼ on base of the lung, and 3/6 holosystolic murmur at apex. ECG revealed sinus tachycardia with ST-segment elevation from V1-V4. Troponin I raised to 10ng/mL. Echocardiography (TTE) showed LVEF 45%, akinetic mid to apical anteroseptal, Intreaventricular septum defect 2cm with left to right shunt. Angiography showed normal coroner. The patient diagnosed as anterior STEMI killip IV with VSR e.c blunt chest trauma. After we stabilized the patient for 2 weeks with inotropic and diuretic we evacuate the patient to Siloam Hospital Jakarta with commercial flight to perform VSD closure. Further follow up showed the surgery succesful and the patient survived without any symptoms.
Discussion: VSR following MI is a life threatening complication however the survival rate is 47% with VSR Closure. The timing for VSD closure usually after the 3rd week. Early stabilitation with DAPT, inotropic, diuretic are crucial because most death happens during the waiting period. In case there is no facilities for VSD closure we have to consider evacuate the patient with full back up of team with close monitor during the flight. Following the succesfull surgery the DAPT are not continued.
Conclusion: Early diagnosis, stabilization, and closure of VSR would give better prognosis for the patient.
KEYWORDS : Ventricular septal rupture, blunt chest trauma