CONGRESS ABSTRACT

Introduction Commotio cordis (CC) is defined as sudden cardiac arrest due to blunt trauma to the left chest area directly over the heart in absence of underlying structural heart disease. Implanted defibrillator in CC offer no benefit in preventing future similar episodes. Clinical case We present the case of a 15-year-old boy with repaired tetralogy of Fallot, who presented with an episode of ventricular fibrillation triggered by chest trauma. The patient had a history of tetralogy of Fallot underwent systemic-pulmonary shunt surgery at the age of 3. Subsequent complete correction at the age of 6 (transannular patch in the presence of complete occlusion of the left pulmonary artery). At the age of 7 stent implantation on the right pulmonary artery. He had been asymptomatic until he was hit by a ball in the left chest area during a football match with some friends. Immediatly after the blow he had cardiac arrest due to ventricular fibrillation. Patient was quickly treated with DC-shock, sinus rhythm was achieved. On admission, the patient was stable and in sinus rhythm (fig 1). Electrophysiological study was performed without induction of ventricular arrhythmia. Cardiac catatherism showed gradient at the junction between the right efflux tract and the stent. A pulmonary valve replacement was performed with bioprostheses for the degeneration of the ventricular-pulmonary duct and right pulmonary artery stenosis (fig 2). Conclusion To the best of our knowledge this is the first described case of ventricular fibrillation due to blunt trauma in a patient with repaired Fallot thetralogy. Diagnosis of CC is made when the following are present: (1) a witnessed event of direct chest wall contact occurred and was followed by near-immediate cardiac arrest, (2) ECG recordings at or around the cardiac arrest demonstrated VF/ VT, and (3) subsequent studies confirmed the absence of underlying structural heart disease. In our case the first and second criterion are present, but not the third. Should have implanted a defibrillator in this young patient? The decision is not easy but was decided to watch and wait. After a follow-up of 5 years our patient had no more events.