Worsening hypoxemia with mechanical ventilation in posttraumatic ventricular septal defect

Excerpt

A 40-year-old woman presented with cardiogenic shock (CS) after having an accidental axial fall from a height of 3 m. Transthoracic echocardiography (TTE) showed a ventricular septal defect (VSD; Fig. 1a) of approximately 1.9 cm with a moderate left-to-right shunt flow across the perimembranous region (Fig. 1b) of the ventricular septum associated with severe mitral regurgitation. Mechanical ventilation with positive end-expiratory pressure (PEEP), presumably through an increase of right ventricular (RV) afterload, induced a severe shunt making the hypoxaemia more severe and refractory (Fig. 1c, d). Considering the presence of CS and severe respiratory failure, surgical closure of the VSD and repair of the incompetent mitral valve were performed allowing a significant improvement in both gas exchange and hemodynamic profile.

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