Ventricular septal rupture: successful delayed repair

Area of Science:

• Cardiology
• Cardiac Surgery

Background:

• Ventricular septal rupture (VSR) is a rare but serious complication of acute myocardial infarction (MI), occurring in about 1% of cases.
• Operative mortality for VSR repair is significantly reduced when surgery is delayed until the infarcted tissue has healed and gained strength.

Observation:

• Immediate surgical intervention for VSR is often necessitated by heart failure or cardiogenic shock, precluding delayed repair.
• This case report details a patient with VSR post-MI who was initially stabilized using an intra-aortic balloon pump.

Findings:

• The patient was discharged and successfully underwent definitive VSR repair 5 weeks later using the Daggett technique with a bovine pericardial patch.
• Mitral annuloplasty was performed concurrently to address associated regurgitation.
• Post-repair recovery was uneventful, with cardiac ultrasound confirming no residual defect at discharge.

Implications:

• Delayed surgical repair of VSR, facilitated by hemodynamic stabilization, can be a safe and effective strategy.
• This approach may improve outcomes by allowing for tissue healing prior to definitive surgical intervention.
• Intra-aortic balloon pump support is a valuable tool for managing VSR patients awaiting delayed repair.