LEFT-VENTRICULAR TO RIGHT ATRIAL SEPTAL-DEFECT SECONDARY TO BLUNT THORACIC TRAUMA DIAGNOSED BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY

A case report is presented of a 58-year-old man who developed a new holosystolic murmur 4 months after a high-speed motor vehicle accident. Cardiac catheterization demonstrated a left-to-right shunt at the right atrial level. Intraoperative transesophageal echocardiography (TEE) identified and localized a discrete atrioventricular septal defect associated with a shunt from the left ventricle to the right atrium without tricuspid regurgitation, findings that were confirmed after surgical exploration. TEE is recommended for patients with a heart murmur and a history of blunt cardiac trauma, may permit early diagnosis, and may allow surgical repair in selected patients without pre-operative catheterization.