Massive fatal ventricular septal defect due to nonpenetrating chest trauma in a six-year-old boy: the role of early invasive monitoring in an evolving lesion.

Isolated ventricular septal defects due to nonpenetrating chest trauma are unusual lesions in adults and very rare in children. A review of the literature and of the natural course of traumatic ventricular septal defects is discussed, with emphasis on the evolving course and frequent late appearance of this lesion. Surgical closure is the treatment of choice, most often performed electively following medical treatment. Defects resulting in progressive severe congestive heart failure must be repaired emergently. The key to successful outcome is early suspicion of such a defect in the presence of heart failure following a period of relative cardiovascular stability. Anticipation of evolving myocardial dysfunction in the presence of seemingly minor chest wall injury and nonspecific electrocardiographic changes is emphasized. A case of a fatal traumatic ventricular septal defect is presented. The importance of early invasive monitoring with proper interpretation of hemodynamic data is discussed.