Late Presentation and Surgical Repair of Traumatic Ventricular Septal Defect Caused by an Old Gunshot Wound

BACKGROUND: The etiology of ventricular septal defect (VSD) includes myocardial infarction, heart surgery, trauma, or congenital causes. CASE SUMMARY: A 65-year-old man had an intracardiac gunshot wound repaired in 1987. Thirty-seven years later, a left ventricular outflow tract-right ventricular outflow tract VSD along the projectile's path was diagnosed. Preoperative imaging showed a left-to-right shunt that was missed in 1987. Heart surgery was performed to repair the left ventricular outflow tract-right ventricular outflow tract VSD and fix and repair the tricuspid valve and pulmonary valve, respectively. DISCUSSION: In intracardiac trauma, the focus is hemodynamic stabilization and mortality prevention. Early complete repair in collaboration with cardiac and trauma surgery is vital to avoid long term complications such as heart failure and end organ failure. TAKE HOME MESSAGES: We recommend the routine use of intraoperative transesophageal echocardiography to assess intracardiac damage to guide a full repair for intracardiac trauma cases. This case also highlights the importance of patient follow-up after intracardiac trauma.