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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
07:41

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Published on: February 8, 2022

Silent myocardial infarction complicated by asymptomatic ventricular septal defect and deferred rupture of left

A H Davies1, S Westaby

  • 1The Department of Cardiothoracic Surgery, John Radcliffe Hospital, Headington, Oxford, England.

Texas Heart Institute Journal
|January 1, 1990
PubMed

Insights

A silent myocardial infarction led to an undiagnosed ventricular septal defect. A second cardiac event revealed a pseudoaneurysm, successfully treated with surgery for both conditions.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery

Background:

  • Postinfarction ventricular septal defects (VSD) and left ventricular pseudoaneurysms (LVPSA) typically present with acute, severe symptoms.
  • Silent myocardial infarction (MI) can lead to delayed and asymptomatic cardiac complications.

Purpose of the Study:

  • To report a rare case of a patient with a silent MI, developing an asymptomatic VSD, followed by a second MI with LVPSA and exsanguination.
  • To highlight the diagnostic challenges and successful surgical management of combined postinfarction VSD and LVPSA.

Main Methods:

  • Case report of a 59-year-old male patient.
  • Diagnostic workup included electrocardiogram (ECG), echocardiography, left ventriculography, and coronary angiography.
  • Surgical intervention involved aneurysm resection, VSD repair, and coronary artery bypass grafting (CABG).

Main Results:

  • The patient presented with symptoms after a second cardiac event, revealing an old anterior MI, a VSD, and a large, exsanguinating anterior LVPSA.
  • Severe two-vessel coronary artery disease was identified.
  • Successful surgical repair of the VSD and LVPSA, along with CABG, resulted in good recovery.

Conclusions:

  • Combined postinfarction VSD and LVPSA can occur after a silent MI and present atypically.
  • Prompt diagnosis and surgical intervention are crucial for favorable outcomes in such complex cases.
  • This case underscores the importance of comprehensive cardiac evaluation even in the absence of initial overt symptoms.

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