Spontaneous closure of ventricular septal perforation following percutaneous coronary intervention for acute myocardial infarction

Abstract

We report on an 84-year-old woman with anteroseptal acute myocardial infarction. Emergency coronary angiography revealed the occlusion of proximal left anterior descending artery without collateral circulation, and percutaneous coronary intervention was performed. Two drug eluting stents were implanted, and the procedure was concluded with thrombolysis in myocardial infarction grade 3 without complications. Postoperatively, no murmur was audible on auscultation and no shunt flow was observed on transthoracic echocardiography (TTE), and normal blood pressure was maintained. On day 2, however, the patient's vital signs deteriorated to a state of shock and systolic murmur appeared at the apical region. TTE showed a left-to-right shunt in the apical septal region, and ventricular septal perforation was diagnosed. Although emergency surgery was considered, the patient's vital signs improved the following day. The disappearance of the cardiac murmur and the shunt was confirmed. The clinical course was uneventful thereafter, and the patient was discharged.

Analysis of Risk Factors of Acute Myocardial Infarction Combined with Ventricular Septal Rupture

“…Exclusion criteria: (1) Other types of myocardial infarction; (2) Sudden cardiac arrest or pulseless electrical activity may have ventricular septal defect; (3) Infective endocarditis, neoplasms in the heart, or other infections (4) Combined with hemorrhagic disease and thrombocytopenia; (5) Combined with obvious liver and kidney dysfunction; (6) Heart insufficiency, intolerance of surgery; (7) Severe valvular disease requires surgical treatment; (8) The survival period of other malignant diseases is less than 6 months.…”

“…Unfortunately, despite the decrease in incidence, the mortality (41-80%) and prognosis of such patients are still poor [1,5,6]. Studies have confirmed that elderly women, anterior myocardial infarction without collateral circulation are risk factors for ventricular septal rupture after acute myocardial infarction [7,8]. Basic research shows that matrix metalloproteinases and inflammatory cytokines play an important role in patients with ventricular septal rupture after myocardial infarction [9,10].…”