Post-myocardial infarction left ventricular septal dissecting aneurysm: a case report

Area of Science:

• Cardiology
• Cardiac Surgery

Background:

• Post-infarction ventricular septal perforation is a known complication of myocardial infarction.
• Ventricular dissection is rarely reported and often associated with shunts causing cardiogenic shock.
• This case presents a rare instance of ventricular dissection without a shunt leading to shock.

Purpose of the Study:

• To report a rare case of ventricular dissection following myocardial infarction.
• To emphasize the importance of considering ventricular dissection in cases of post-MI cardiogenic shock.
• To highlight a successful surgical approach for this rare complication.

Main Methods:

• A 67-year-old male presented with acute myocardial infarction and left ventricular rupture.
• Initial management included revascularization, pericardial drainage, and hemostasis.
• Subsequent development of cardiogenic shock led to diagnosis of ventricular septal dissection with pseudoaneurysm via transesophageal echocardiogram.
• Surgical repair of the ventricular septal tear was performed.

Main Results:

• The patient developed sudden cardiogenic shock 15 hours post-MI, requiring extracorporeal membrane oxygenation (ECMO).
• Transesophageal echocardiogram revealed a left ventricular septal aneurysm, later identified as dissection with a pseudoaneurysm during surgery.
• Successful surgical closure of the tear allowed weaning from ECMO and stable discharge after 4 months.

Conclusions:

• Ventricular septal dissection is a critical, albeit rare, complication of myocardial infarction that can cause cardiogenic shock.
• Early recognition and surgical intervention are crucial for managing this condition.
• Clinicians should consider ventricular septal dissection alongside other common post-MI complications like papillary muscle rupture and septal perforation.