Delayed Presentation of a Post-infarction Ventricular Septal Rupture.

Area of Science:

• Cardiology
• Cardiac Surgery
• Internal Medicine

Background:

• Ventricular septal rupture (VSR) is a severe complication of acute myocardial infarction (AMI), often leading to significant morbidity and mortality.
• Clinical presentation typically involves hemodynamic compromise requiring urgent surgical intervention.

Observation:

• A 60-year-old male presented with acute heart failure three weeks after a presumed AMI.
• Diagnostic evaluation revealed a substantial ventricular septal defect with a left-to-right shunt.
• Despite the defect's size, the patient was hemodynamically stable with only mild symptoms.

Findings:

• Surgical closure of the ventricular septal defect was performed.
• Coronary artery bypass grafting was also conducted for multivessel coronary artery disease.
• The patient's delayed presentation and relative stability were notable given the VSR's extent and timing post-MI.

Implications:

• This case expands the understanding of post-MI ventricular septal rupture, particularly its less common delayed presentations.
• It suggests that VSR may not always manifest with severe hemodynamic instability, even with significant defects.
• Highlights the importance of considering VSR in patients with heart failure post-MI, regardless of initial hemodynamic status.