Complex ventricular septal rupture. The pivotal role of transesophageal echocardiography as support to surgery

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Inferior myocardial infarction can lead to severe complications, including right ventricular dysfunction and cardiogenic shock.
• Septal rupture is a rare but life-threatening mechanical complication of myocardial infarction, often associated with high mortality.
• Early diagnosis and intervention are critical for managing patients with post-myocardial infarction septal rupture.

Observation:

• A 73-year-old male presented with inferior myocardial infarction, right ventricular dysfunction, and Killip class IV, progressing to cardiogenic shock and diagnosed septal rupture.
• Intraoperative transesophageal echocardiography (TEE) identified a complex inferior septal rupture, necessitating surgical repair via the infarct exclusion method.
• Postoperative recurrence of the shunt and hemodynamic instability required a second surgical intervention.

Findings:

• Successful surgical repair of a complex inferior septal rupture using the infarct exclusion method was achieved.
• A redo operation was required due to partial patch dehiscence, with successful suture restoration confirmed by intraoperative TEE.
• The patient achieved full recovery of right ventricular function and was discharged 45 days post-admission.

Implications:

• Surgical repair of post-myocardial infarction septal rupture, even in severe cases, can lead to favorable outcomes.
• Intraoperative TEE is crucial for diagnosing complex septal defects and guiding surgical repair, as well as for detecting and managing postoperative complications.
• This case highlights the importance of prompt surgical intervention and vigilant postoperative monitoring in managing mechanical complications of myocardial infarction.