Postinfarction Ventricular Septal Rupture With Thin Membrane Preventing Cardiopulmonary Collapse

Area of Science:

• Cardiology
• Cardiovascular Surgery

Background:

• A 53-year-old male presented with symptoms of heart failure, including dyspnea, orthopnea, and paroxysmal nocturnal dyspnea, one week post-myocardial infarction.
• Clinical examination revealed hemodynamic stability despite heart failure signs and a pansystolic murmur, suggesting a significant cardiac abnormality.

Purpose of the Study:

• To report a rare case of a post-myocardial infarction ventricular septal defect (VSD) presenting with a unique membranous structure.
• To describe the diagnostic approach and successful surgical management of this complex cardiac condition.

Main Methods:

• Diagnostic evaluation included electrocardiogram (ECG), echocardiography, and coronary angiography.
• Surgical intervention involved delayed patch repair of the ventricular septal defect and coronary artery bypass grafting (CABG).

Main Results:

• Echocardiography identified a large basal inferior VSD with a thin septal membrane exhibiting a small defect and left-to-right shunting.
• Coronary angiography confirmed an occluded right coronary artery.
• The patient underwent successful delayed patch repair and bypass graft surgery, with no requirement for presurgical hemodynamic support due to the membrane's temporary stability.

Conclusions:

• A post-myocardial infarction VSD can present with unusual features, such as a thin membranous septum, which may temporarily maintain hemodynamic stability.
• Timely surgical intervention, including VSD repair and revascularization, is crucial for managing such complex cardiac complications.