Author + information
- Received May 27, 2016
- Revision received June 14, 2016
- Accepted June 20, 2016
- Published online September 12, 2016.
- Rajiv Bharat Kharwar, MD, DM∗ (, )
- Tarun Madan, MD, DNB,
- Bhavesh Thakkar, MD, DM,
- Anand Shukla, MD, DM and
- Jagjeet Deshmukh, MD, DM
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
- ↵∗Reprint requests and correspondence:
Dr. Rajiv Bharat Kharwar, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India.
A 25-year-old male presented to us 3 days after experiencing a stab knife injury to the left third intercostal space. Cardiac computed tomography (Figures 1A and 1B) showed moderate hemopericardium, autosealed perforation in the right ventricle and a large ventricular septal rupture (VSR). Two-dimensional transthoracic echocardiography with color Doppler (Figures 1C and 1D, Online Video 1) showed mild pericardial effusion, a large high muscular VSR with left to right shunt and an autosealed perforation in the right ventricle. Three-dimensional transthoracic echocardiography clearly delineated the size (13 × 3 mm) and the slitlike shape of the VSR from the left ventricular aspect and the right ventricular aspect.
After informed consent, patient was taken up for percutaneous device closure of the VSR as the right ventricular rent was autosealed and the pericardial effusion was resolving. Right ventriculogram did not show any pericardial leak. Left ventriculogram showed a high muscular VSR. The Qp/Qs ratio was 2:1. An arteriovenous loop was successfully established using Judkin’s right diagnostic catheter, a 0.035-inch Terumo hydrophilic wire and a snare. A 10-F Cook delivery system was than advanced from the venous side, using rail road technique, and placed into the left ventricle (Figure 2A, Online Video 2). A 16-mm Amplatzer muscular VSD occluder device was than successfully deployed across the defect in the traditional manner. Left ventriculogram (Figure 2B) and aortic root angiogram showed no flow across the defect and no aortic regurgitation, respectively. Post-procedural 2-dimensional transthoracic echocardiography (Figure 2C, Online Video 3) showed device fitting across the VSR with no flow across the defect. Three-dimensional echocardiography clearly showed the right ventricular as well as the left ventricular disc (Figure 2D) of the device. The post-procedural course was uneventful and patient was discharged in hemodynamically stable condition.
For supplemental videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 27, 2016.
- Revision received June 14, 2016.
- Accepted June 20, 2016.
- 2016 American College of Cardiology Foundation