Desenvolvimento tardio de insuficiência cardíaca congestiva em comunicaçäo interventricular por ferimento penetrante, com resoluçäo da hipertensäo pulmonar após correçäo cirúrgica / Late Development of Congestive Heart Failure After a Stab Wound Ventricular Septal Defect with Regression of Wound Ventricular Septal Defect with Regression of Pulmonary Hypertension After Surgical Intervention

Male, 33 years-old, with onset of heart failure and edema; he used to be completely asymptomatic but mentioned he underwent previously a pleural drainage, after a hemothorax provoked by a stab wound. His physical examination confirmed he was in heart failure and showed a harsh holosystolic murmur between mitral and tricuspid areas. Cardiac catheterization demonstrated a large apical ventricular septal defect (VSD) and systemic pulmonary arterial pressures. With oxygen there was an increase in the left to right shunt and normal pulmonary vascular resistance. The clinical diagnosis was that of a traumatic VSD provoking pulmonary hypertension although a congenital etiology could not be completely ruled out. At surgery there was a sharp cut at the pericardium and an apical epicardial lesion; the VSD was patch sutured and the patient did well with control of his heart failure. A control hemodynamic study performed within the first postoperative month showed no residual shunt and complete normalization of the pulmonary pressures and resistance