Ischemic ventricular septal rupture with patent coronary bypass grafts due to occluded septal branch, a case report

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Ischemic ventricular septal rupture (VSR) is a rare but fatal complication following coronary artery occlusion.
• While patent coronary artery bypass grafts (CABGs) are generally protective, VSR can still occur.
• This case presents a unique scenario of VSR post-septal branch occlusion despite patent grafts.

Observation:

• A patient with patent left internal mammary artery (LIMA) to the left anterior descending artery (LAD) and patent grafts to the posterior descending artery developed VSR.
• The VSR was attributed to the occlusion of a major septal branch, not the main epicardial vessels.
• This represents the first reported case of VSR following septal branch occlusion in a patient with patent coronary artery grafts.

Findings:

• Patent coronary artery grafts, including LIMA to LAD, did not prevent VSR in this case.
• Occlusion of a major septal branch was the direct cause of the ischemic VSR.
• Collateral circulation, typically protective against myocardial necrosis, may not always prevent VSR in such cases.

Implications:

• This case underscores that patent grafts do not guarantee protection against VSR.
• Significant disease in major septal branches warrants consideration for percutaneous intervention.
• Cardiology and cardiac surgery teams should carefully evaluate septal artery disease in patients at risk for VSR.