WOFAPS 2025 8th World Congress of Pediatric Surgery

Y Doruk Bilgili ¹, B Haluk Güvenç ²

¹ Bandırma Onyedi Eylül University, Dept. of Pediatric Surgery, Balıkesir, Turkey
² Istanbul Okan University, Faculty of Medicine, Department of Pediatric Surgery, Istanbul, Türkiye

Introduction

Trauma related cardiovascular pathologies represent the second most common cause of death following intracranial hemorrhage. Blunt thoracic traumas due to traffic accident or fall from height may conceal the degree of the underlying injury, leading underestimation of the true clinical picture.

Case Presentation

Two pediatric poly-traumatized male patients (3 and 16 y) were admitted to the emergency room following traffic accidents. First patient was overrun by a motor vehicle and seemed to be doing well in ICU when all of a sudden, he developed heart failure with hemodynamic instability on day 14. Transesophageal and color flow Doppler echocardiography demonstrated an acquired 10 mm ventricular septal defect with left-to-right shunting into right pulmonary artery. Second case demonstrated left sided hemo-mediastinum and hemo-pneumothorax, spleen, liver and kidney injury following motorcycle accident. Radiology further revealed an image suggesting thoracic aortic transection.

Initial case underwent a successful repair of the ventricular septal defect via open cardiac surgery, discharged on day 35 with neurological rehabilitation program. A transcatheter aortic stent graft was successfully placed in the second case, discharged on the 16th postoperative day. No significant problems were encountered during subsequent follow-ups.

Conclusion

Although it is rare, in severe thoracic trauma we must be aware of the possibility and search for the presence of a silent cardiovascular or intracardiac injury, as it may be fatal in origin requiring rapid intervention.