• F X Roithinger, C Punzengruber, and O Pachinger.
• II Interne Abteilung/Kardiologie, Allgemeines öffentliches Krankenhaus der Barmherzigen Schwestern vom Heiligen Kreuz, Wels.
• Dtsch. Med. Wochenschr. 1996 Nov 15;121(46):1424-7.

History And Clinical FindingsCase 1: a 20-year-old previously healthy man sustained multiple nonvascular injuries without visible chest trauma in a car accident. Four days later a loud systolic murmur was heard over the heart. Case 2: a 21-year-old man similarly sustained in a car accident multiple injuries without visible chest involvement but causing haemorrhagic shock. A loud systolic heart murmur was heard and after shock treatment he developed left heart failure requiring catecholamine infusions.InvestigationsEchocardiography demonstrated posttraumatic ventricular septal rupture in both patients. Cardiac catheterisation revealed a small left to right (1 : 1.6) shunt in case 1, and a large one, 1 : 3, with markedly elevated pulmonary artery pressure in case 2.CourseIn case 1, no treatment was needed as the intracardiac shunt was small and there were no symptoms. But in case 2 the large shunt with pulmonary hypertension required operative closure with a Dacron patch 2 days after the diagnosis had been established.ConclusionVentricular septal rupture after blunt trauma to the chest is a rare occurrence. Even though in general the prognosis is good, a large intracardiac shunt may require early surgical repair.

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