Home » 2009 » Number 09-18: Traumatic interventricular septal dissection

Number 09-18 Traumatic interventricular septal dissection

Case from: Qinyi Dai,MD; Zhaoqi Zhang,MD; Honghong Tie, PhD; Meng Li,PhD.
Department of Radiology, AnZhen Hospital, Capital Medical University, Beijing, China.  

Clinical history: A 15-year-old boy suffered a traumatic splenic rupture folowwing a 10 foot fall into a gutter. Following an emergency splenectomy, he was noted to have a systolic murmur at the left sternal edge. Bedside echocardiography demonstrated a a small VSD and an interventricular septal dissection.
A CMR was performed since the patient was haemodynamically stable and to allow better surgical planning for repair.

Movie 1

Movie 2

CMR findings: the SSFP cine long-axis 4-chamber (Movie 1) and mid-cavity short-axis (Movie 2) views demonstrated an interventricular septal dissection measuring 6.5x2.0x4.0cm in addition to a  2.5x3.5cm VSD causing a left to right shunt.
The corresponding still images (Figure 1 and 2) show separation of the inferior interventricular septum (*) and orifice of the left-sided septal wall (black arrow).
In addition, a small pericardial effusion was also noted (white arrow).    

Figure 1

Figure 2

Figure legend: RA=right atrium, LA=left atrium, LV=left ventricle, RV=right ventricle

Figure 3

LGE imaging was also performed. The images are suboptimal but there is suggestion of LGE in the septum indicating myocardial necrosis (white arrow) (Figure 3).

Following the CMR, the patient underwent surgical VSD repair with a pericardial patch and direct suture with a good surgical result (Movie 3).

Movie 3

Perspective: Echocardiography has been widely used in traumatic cardiac injuries.However, MRI is more advantageous by precisely imaging the desired structures, hence enabling the surgeon to plan a definite operative strategy.

References

1. Pretre R, Chilcott M. Blunt trauma to the heart and great vessels. N Engl J Med.1997;336:626-632.
2. Dogan H, Bax JJ, de Roos A, Kroft LJ. Ventricular septum rupture after myocardial infarction demonstrated by multislice computed tomography. Circulation. 2005;111(25):e449-e450.
3. Yerebakan C, Westphal B, Liebold A, Steinhoff G. Ventricular septal dissection after patch repair of an infarct-related ventricular septal rupture. Eur J Cardiothorac Surg. 2008;33(6):1141.

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