Post-myocardial infarction ventricular septal rupture in a patient with large secundum atrial septal defect: a case report

Abstract

Background Ventricular septal rupture (VSR) is an uncommon but potentially fatal complication of acute myocardial infarction (AMI). The management of VSR is challenging, and its surgical correction is associated with the highest mortality among all cardiac surgery procedures. Case summary A 57-year-old man with a history of smoking presented with AMI with a large apical VSR in addition to a large secundum atrial septal defect (ASD). His left ventricular ejection fraction was 30%, and the right ventricle was moderately dilated with normal systolic function. Cardiac catheterization revealed that the left anterior descending artery was diffusely diseased with total mid occlusion, whereas other coronary arteries had non-obstructive disease. This unique combination resulted in distinctive presentation with paradoxically better outcomes. After stabilization, the patient’s interventricular septum was reconstructed, and the ASD was closed with a pericardial patch. The post-operative period was uneventful, and the patient was discharged 1 week after surgery. A follow-up echocardiography revealed no residual shunt. Discussion Post-myocardial infarction VSR presents differently in patients with pre-existing right ventricular volume overload. In such cases, the absence of significant cardiogenic shock at presentation may result in better surgical outcomes.

Ventricular Septal Rupture (VSR) in Post-Acute Anterior Myocardial Infarction Patients : A Case Series

“…It is fatal mechanical complications of AMI. Although it is rare, it has a very high mortality and morbidity rate [3][4][5] . Currently the incidence is decreasing due to reperfusion therapy [1,2,8,9] .…”

“…Ventricular septal rupture (VSR) is one of the fatal mechanical complications of AMI. Although it is rare, it has a very high mortality and morbidity rate [3][4][5] . The incidence of VSR in the prereperfusion era ranges from 1-2%.…”

“…The incidence of VSR in the prereperfusion era ranges from 1-2%. Currently, after September 2022 | Vol 3 | Article 4 various methods of reperfusion are available, the incidence of VSR is decreasing, ranging from 0.17 to 0.31% [3,4,6] . However, the mortality rate is still very high.…”

Myocardial infarction with non obstructive coronary arteries complicated with ventricular septal rupture: A case report and literature review

“…11 To our knowledge, this is one of the very few case reports in the literature of a patient suffering an acute coronary syndrome with normal coronary arteries and subsequent VSR 24 h after catheterization and 30 h after hospital admission. [11][12][13][14][15] Possible explanations for the VSR after the acute coronary event may be either spasm or plaque erosion (more common in NSTEMI, younger age and absence of the 'traditional' cardiovascular risk factors) or paroxysmal atrial fibrillation, that led to transient epicardial thrombosis and/or occlusion or an ostial and isolated occlusion of a large septal perforator that could not be visualized during the coronary angiography procedure.…”

Transcatheter closure of post myocardial Infarction ventricular septal rupture with the Amplatzer Septal occluder

“…Historically the incidence of VSR was about 1-2% but recent data suggest that it complicates 0.17-0.31% of AMI 2 .Guidelines of the American College of Cardiology and American Heart Association recommends immediate surgical correction regardless of the patient's haemodynamic status 3 . Despite modern surgical techniques, specialized cardiac anesthesia and myocardial protection during cardiac surgery, surgical outcomes remain poor and mortality is high 1,4,5 . In recent years, transcatheter closure of VSR has been proposed as an alternative to surgical repair as it is less invasive and might allow for immediate complete VSD closure allowing initial hemodynamic stabilization 6 .…”