Ventricular septal rupture with "normal" coronary arteries

A 73-year-old woman was admitted to St. Margaret's Hospital with a history of an acute anteroseptal infarction, a loud cardiac murmur, and low cardiac output. Cardiac catheterization revealed a large, high ventricular septal defect and normal coronary arteries. Despite successful closure of the ventricular septal rupture, death occurred in the operating room due to severe right ventricular dysfunction. Although this patient had normal major coronary arteries, a ventricular septal rupture developed, which was probably caused by spasm or isolated atherosclerotic disease of a large septal perforator.