Delayed ventricular septal rupture after percutaneous coronary intervention in acute myocardial infarction

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Ventricular septal rupture (VSR) is a rare but serious complication of acute myocardial infarction (AMI).
• Historically, VSR occurred in approximately 1-3% of AMIs before reperfusion therapy, typically 3-5 days post-event.
• A correlation exists between VSR incidence and coronary artery occlusion severity.

Observation:

• A 70-year-old female presented with acute anterior myocardial infarction (MI) and recent cerebral infarction.
• Coronary angiography revealed 90% stenosis in the left anterior descending artery (LAD), treated successfully with percutaneous coronary intervention (PCI) and stent implantation.
• Despite initial improvement in anterior wall motion post-PCI, the patient suddenly deteriorated on day 20 with pulmonary congestion.

Findings:

• Echocardiography identified a 1.3 cm ventricular septal defect (VSD) in the apical septum with a left-to-right shunt.
• This represents a rare case of delayed septal rupture occurring 20 days after PCI in a patient with a patent LAD and recovered wall motion.

Implications:

• This case underscores the possibility of delayed VSR even after successful revascularization and initial recovery.
• It highlights the need for continued vigilance and monitoring for uncommon complications following acute myocardial infarction management.
• Further research may be warranted to understand the mechanisms and risk factors for late-onset VSR in the context of modern interventional therapies.