A Delayed Approach to Ventricular Septal Defect Repair After Myocardial Infarction

A ventricular septal defect (VSD) is a rare but potentially fatal complication of myocardial infarction, with a mortality rate approaching 100% if managed conservatively. Patients typically present with cardiogenic shock, necessitating either percutaneous or surgical repair. However, the optimal timing of the repair remains unclear.

We report the case of a 69-year-old male smoker with no comorbidities who developed an anterior wall ST-segment elevation myocardial infarction complicated by a VSD. He was initially managed conservatively. Four weeks later, he underwent coronary artery bypass grafting and surgical closure of the VSD.

This delay contrasts with current guidelines (2013 ACCF/AHA; 2021 ACC consensus), which recommend urgent VSD closure after myocardial infarction. Surgery was deferred owing to the patient's stability, which permitted infarct maturation and reduced the risk of patch dehiscence.

In stable post-myocardial infarction VSD, individualized delayed surgery after optimal stabilization may yield excellent long-term outcomes.