RUPTURE OF THE VENTRICULAR SEPTUM AFTER B LUNT CHEST TRAUMA

History and clinical findings: Case 1: a 20-year-old previously health y man sustained multiple nonvascular injuries without visible chest tr auma in a car accident, four days later a loud systolic murmur was hea rd over the heart. Case 2: a 21-year-old man similarly sustained in a car accident multiple injuries without visible chest involvement but c ausing haemorrhagic shock. A loud systolic heart murmur was heard and after shock treatment he developed left heart failure requiring catech olamine infusions. Investigations: Echocardiography demonstrated postt raumatic ventricular septal rupture in both patients. Cardiac catheter isation 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 i n case 2. Course: In case 1, no treatment was needed as the intracardi ac shunt was small and there were no symptoms. But in case 2 the large shunt with pulmonary hypertension required operative closure with a D acron patch 2 days after the diagnosis had been established. Conclusio n: Ventricular septal rupture after blunt trauma to the chest is a rar e occurrence. Even though in general the prognosis is good, a large in tracardiac shunt may require early surgical repair.