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Delayed ventricular septal rupture complicating acute inferior wall myocardial infarction

Jae Hyung Cho1, Srinivasan Sattiraju, Sanjay Mehta

  • 1College of Medicine, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA.

BMC Research Notes
|March 30, 2013
PubMed

Insights

Delayed ventricular septal rupture can occur after acute myocardial infarction, even with reperfusion therapy. This case highlights the importance of suspecting this rare complication in patients with new murmurs and instability.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction (AMI).
  • Modern reperfusion therapies have decreased the incidence of VSR.
  • VSR typically occurs 18-24 hours after AMI, often associated with anterior wall infarction.

Observation:

  • A 53-year-old male presented with symptoms of acute inferior wall myocardial infarction.
  • Following successful percutaneous coronary intervention, the patient developed respiratory distress, a new pansystolic murmur, and hemodynamic instability on hospital day six.
  • Echocardiography confirmed a large inferobasal interventricular septal defect with a significant left-to-right shunt.

Findings:

  • The patient was diagnosed with delayed ventricular septal rupture complicating acute inferior wall myocardial infarction.
  • Surgical repair using a bovine pericardial patch was successfully performed.

Implications:

  • Ventricular septal rupture should be suspected in post-myocardial infarction patients with new physical findings and hemodynamic compromise, irrespective of revascularization status.
  • This case underscores the importance of vigilance for VSR even in atypical presentations like inferior wall MI.
Abstract

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