Post-infarction ventricular septal defect: triggered by Valsalva manoeuvre?

Area of Science:

• Cardiology
• Cardiac Surgery

Background:

• Post-infarction ventricular septal defect (VSD) is a severe mechanical complication of myocardial infarction.
• While its incidence has decreased due to reperfusion therapies, VSD remains associated with high mortality.
• Management strategies, including timing of surgical intervention, are debated.

Observation:

• A case of post-infarction VSD developed severe hemodynamic instability after a Valsalva maneuver on day six of a non-reperfused inferior myocardial infarction.
• The patient presented with critical instability necessitating immediate intervention.

Findings:

• Early surgical repair of the post-infarction VSD was successfully performed using a trans-aneurismal approach.
• This approach facilitated timely closure of the defect in a high-risk scenario.

Implications:

• This case demonstrates the feasibility and success of early surgical VSD repair in select hemodynamically unstable patients.
• It suggests that a trans-aneurismal approach can be a viable option for managing acute post-infarction VSD.
• Further research may clarify optimal timing and surgical techniques for post-infarction VSD management.