Blunt cardiac trauma induced all types of left ventricular trauma in a 3-year-old girl

Blunt cardiac trauma (BCT) is a life-threatening cardiac emergency. BCT and the resultant left ventricular trauma (LVT) include mitral valve avulsion, ventricular septal injury, and traumatic ventricular aneurysms. Only a few isolated types have been reported in the existing literature. We report the youngest patient with LVT. Moreover, it included all types of this trauma and was diagnosed at the same time. A 3-year-old girl was transported to our emergency room with severe substernal pain and upper abdominal pain after being hit by an agricultural vehicle. She was conscious the entire time, with a blood pressure of 90/50 mmHg, a heart rate of 145 beats per minute, a respiratory rate of 30 breaths per minute, and an oxygen saturation of 100% while breathing the ambient air in the emergency room. A few scattered wet rales were heard in both lungs, and no obvious murmurs were heard on cardiac auscultation. Radiological examination did not reveal any specific organ damage, including bone, abdominal organs, or skull. She was given oxygen, expectorant, and symptomatic treatment. Three days later, the child suddenly began sweating profusely, did not want to move, and exhibited weak crying. Physical examination revealed a systolic murmur of Levine grade II–III/VI heard near the cardiac apex, which was increased by inspiration. Electrocardiogram showed a sinus tachycardia with ST-T segment elevation (Panel A). An initial transthoracic echocardiogram showed multiple aneurysms in the posterior wall and inferior wall of the left ventricle (Panel B), with the abnormal aneurysms increasing during systole and decreasing during diastole (the two largest measurements were 20.9 mm × 8.0 mm and 14.1 mm × 6.4 mm, Supplementary material online, Video). Moreover, a bulge was also found in the interventricular septum, with a neck measuring 15 mm that was 7 mm deep at its widest diameter (Panel C). The apical four-chamber view with colour flow mapping revealed moderate to severe regurgitation of the mitral valve with a prolapsed anterior leaflet (Panel C). The left ventricle was enlarged, and the ejection fraction was 53% (Panel D). These ventricular aneurysms were also demonstrated by 320-slice computed tomographic scans (Panels E–H). These imaging diagnoses were confirmed by surgery for reconstruction of the left ventricle and mitral valvuloplasty (Panel I).