Exceptional ventricular septal rupture associated with intramyocardial dissection throughout the right ventricle

Ventricular septal rupture (VSR) is an uncommon but a devastating complication of acute myocardial infarction. Wide implementation of thrombolytic therapy in practice has limited the incidence of this complication and changed its time pattern by accelerating the occurrence. In the era of primary percutaneous coronary intervention, this beneficial effect is more pronounced. This paper describes a case with a complex VSR with intramyocardial dissection tract extending throughout the right ventricle and yielding a left to right shunt; where the potential role of ischemia was suspected, but the precise etiology of septal rupture remained ambiguous.