Ventricular septal rupture with right ventricular wall dissection after inferior ventricular infarction: A case report and literature review

Li, Tan; Kong, Fanxin; Wang, Junli; Jun, Yang; Ma, Chao

doi:10.1002/jcu.22684

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…The disease has a poor prognosis, and its clinical outcomes are almost always dismal. According to their summary, VSR closure with an uncorrected left RV wall could improve survival and reduce the ultimate mortality rate compared with no surgery or VSR closure with RV reconstruction [4]. We arrived at the same conclusion.…”

Section: Discussionmentioning

confidence: 52%

A Sandwich Technique Employing Right Ventricular Incision to Repair Posterior Ventricular Septal Rupture with Right Ventricular Wall Dissection: A Case Report

Sakurahara,

Furukawa,

Ishii

et al. 2023

WJCS

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Background: Ventricular septal rupture (VSR) leading to right ventricular (RV) wall dissection is an extremely rare and life-threatening complication of inferior myocardial infarction (MI) with posterior VSR. Its rare incidence and complex pathology make it difficult to select the appropriate surgical procedures to prevent fatalities. Case Presentation: A 68-year-old woman was transferred to our hospital because of a post-infarction VSR 12 days after symptom onset. Short-axis image obtained using transthoracic echocardiography demonstrated a large posterior VSR. Moreover, the VSR was continuous, with a large echo-free space in the posterior wall of the right ventricle. Color echocardiography showed blood flowing into the echo-free space through the septal defect and blood flowing out into the RV lumen. Coronary angiography revealed complete occlusion of the second segment of the right coronary artery. Thus, dissection of the posterior wall of the right ventricle that continued into the RV lumen was considered to have been caused by the posterior VSR caused by an inferior MI. The patient underwent urgent surgery to repair the VSR using the sandwich double-patch technique by making a posterior RV incision that was repaired using a third patch. No additional procedure was required to block the flow from the cavity of the RV wall dissection into the RV lumen. Postoperative echocardiography and contrastenhanced computed tomography demonstrated that the VSR was closed securely and the RV wall dissection was almost completely thrombosed. Conclusion: In this case, a patient with a posterior VSR and RV wall dissection was successfully treated using the sandwich double-patch technique with a posterior RV incision. No additional procedure may be needed for RV wall

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Section: Discussionmentioning

confidence: 52%

A Sandwich Technique Employing Right Ventricular Incision to Repair Posterior Ventricular Septal Rupture with Right Ventricular Wall Dissection: A Case Report

Sakurahara,

Furukawa,

Ishii

et al. 2023

WJCS

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“…A total of 108 reports were identified, of which 22 full‐text articles with 36 cases met our inclusion criteria (including 15 case reports, 3 case series, 2 systematic reviews, one prospective study, and one letter) . The included studies are summarized in Table of the supplementary material.…”

Section: Resultsmentioning

confidence: 99%

Postinfarction intramyocardial dissection, an interesting case report and systematic review

et al. 2019

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Intramyocardial dissection (IMD) with ventricular septal rupture (VSR) following myocardial infarction (MI) is a rare subacute form of cardiac rupture. The evidence available in this regard is scarce. We aimed to share our experience and conduct a systematic review of previous cases. We searched the literature and performed a systematic review of previous cases. A total of 37 cases of IMD with VSR were included (1 our original and 36 literature cases). Mean age was 68 ± 8 years and 20 (54.1%) patients were male. Anterior and inferior MI were observed in 14 (37.8%) and 23 (62.2%) cases, respectively. The dissected area was the septum, RV, both septum and RV, or LV apex in 21 (56.8%), 9 (24.3%), 5 (13.5%), and 2 (5.4%), respectively. Apicoseptal and inferoseptal VSR were observed in 15 (40.5%) and 22 (59.5%) cases, respectively. At least one occluded artery was observed in 29 (90.6%) of cases. Reperfusion therapy was done for 15 (40.5%) cases before the VSR occurred.Surgery, percutaneous, and medical therapy were done for 26 (70.3%), 3 (8.1%), and 7 (18.9%) cases, respectively. The mortality rate was significantly higher in the medical versus surgical-treated group (85.7% versus 42.3%, P = .027). There was a trend to higher mortality in the group with dissection of both septum and RV (P = .15). We concluded that echocardiography has a critical role in diagnosing this complication.Surgery is mandatory in IMD with VSR.

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“…However, due to the potentially fatal nature of this consequence, our patient's condition went undiagnosed and kept deteriorating in the absence of cardiac resuscitation, which was required, and finally he succumbed even without a first aid. Myocardial rupture is rare but fatal complication caused by the death of myocardial muscles resulting in tears or breaks 13–15 . The resulting cardiac tamponade can compress the heart, leading to decreased cardiac output and potentially fatal consequences.…”

Section: Discussionmentioning

confidence: 99%

“…Myocardial rupture is rare but fatal complication caused by the death of myocardial muscles resulting in tears or breaks. 13 , 14 , 15 The resulting cardiac tamponade can compress the heart, leading to decreased cardiac output and potentially fatal consequences. Sudden death can be the first clinical manifestation of underlying disease in individuals who were previously asymptomatic and appeared to be in good health.…”

Section: Discussionmentioning

confidence: 99%

Ventricular silent rupture leading to sudden death: Navigating diagnostic challenges in a resource‐constraint setting

Pallangyo,

Pyuza,

Nkya

et al. 2024

Clinical Case Reports

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Key Clinical MessageVentricular myocardial rupture is a rare complication of myocardial infarction. It occurs within hours to weeks after an infarction. Mortality is high. Antemortem diagnosis is a challenge in low‐resource settings, leading to potential misdiagnosis.AbstractLeft ventricular myocardial rupture is a potentially fatal yet common complication in acute myocardial infarction patients. Rupture can occur as early as hours after an infarction. However, rupture may also occur later in the first week in the setting of myocardial necrosis and neutrophilic infiltration. Patients may survive several days to weeks before rupture occurs, and cardiac tamponade may present subacutely with a slow or repetitive clinical course. Sudden death can be attributed to ventricular rupture, more commonly during this time frame. Myocardial rupture can also occur as a result of trauma, infections, or cancer. Mortality is exceedingly high if surgical intervention is delayed. In most patients, myocardial rupture manifests as a catastrophic event within days of a first, small, uncomplicated acute myocardial infarction. Acute onset of shortness of breath, chest pain, shock, diaphoresis, unexplained emesis, cool and clammy skin, and syncope may herald the onset of ventricular septal rupture after acute myocardial infarction. Sudden death from myocardial rupture during acute myocardial infarction in patients with no apparent previous symptoms of myocardial ischemia represents a challenge for medical examiners, law enforcement officers, and society as a whole. An autopsy is critical for establishing the cause of death. We present the case of a 54‐year‐old male whose body was found beside the road after a trivial quarrel a day before. Further medical information about the deceased was not available. The preliminary cause of death was presumed to be traumatic. No evidence of trauma was seen during the autopsy. Massive pericardial blood collection compressing the heart and concealed left ventricular myocardial rupture were noted. Histopathological examination of the heart demonstrated myocardial infarction with a tear associated with bleeding that was contained in the pericardial sac. We ruled cardiac tamponade as the cause of death due to an infarcted myocardial rupture. Antemortem diagnosis of myocardial rupture can be challenging in low‐resource settings, leading to potential misdiagnosis and negative impacts such as community conflicts.

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Ventricular septal rupture with right ventricular wall dissection after inferior ventricular infarction: A case report and literature review

Cited by 5 publications

References 21 publications

A Sandwich Technique Employing Right Ventricular Incision to Repair Posterior Ventricular Septal Rupture with Right Ventricular Wall Dissection: A Case Report

A Sandwich Technique Employing Right Ventricular Incision to Repair Posterior Ventricular Septal Rupture with Right Ventricular Wall Dissection: A Case Report

Postinfarction intramyocardial dissection, an interesting case report and systematic review

Ventricular silent rupture leading to sudden death: Navigating diagnostic challenges in a resource‐constraint setting

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