Overlooked Ventricular Septal Defect Post-Myocardial Infarction and Coronary Artery Bypass Grafting

Area of Science:

• Cardiology
• Cardiac Surgery

Background:

• Ventricular septal defect (VSD) is a rare but severe complication following myocardial infarction (MI).
• Advancements in reperfusion therapy have decreased VSD incidence post-MI to approximately 0.2%.
• Current guidelines recommend urgent closure of post-infarction VSD (PI-VSD).

Observation:

• A case of a VSD diagnosed 2.5 years after an inferior MI is presented.
• The patient underwent primary percutaneous intervention for the acute MI and later coronary artery bypass grafting (CABG).
• Recurrent ventricular tachycardia (VT) led to hospitalization and diagnosis of a PI-VSD at the inferoseptal wall aneurysm site.

Findings:

• Echocardiography confirmed the VSD at the inferoseptal wall aneurysm.
• An implantable cardioverter-defibrillator (ICD) was implanted due to recurrent malignant arrhythmias.
• Despite a delayed diagnosis and missed opportunity for concomitant repair, the patient achieved 3-year survival.

Implications:

• This case underscores the possibility of late VSD diagnosis post-MI.
• It suggests that long-term survival may be achievable with medical management even in complex PI-VSD cases.
• Highlights the importance of thorough diagnostic evaluation for persistent symptoms after MI.