Transesophageal echocardiography (TEE)-guided management of post-myocardial infarction complications

Intramyocardial dissecting hematoma with cardiac rupture poses catastrophic risks following acute myocardial infarction (AMI). While transthoracic echocardiography (TTE) is standard for initial assessment, transesophageal echocardiography (TEE) provides critical anatomical delineation for surgical planning. A 78-year-old male with multiple cardiovascular risk factors presented with a three-day history of chest pain, diagnosed as ST-segment elevation myocardial infarction (STEMI) by electrocardiogram (ECG). TTE revealed segmental left ventricular wall motion abnormalities and cardiac troponin I (cTnI) levels (10.89 ng/ml) were markedly elevated. Despite guideline-directed antithrombotic therapy, he developed acute decompensated heart failure with progressive lower limb edema by day 9, at which point TTE revealed ventricular septal rupture (VSR) with contained perforation. Following 30 days of continuous renal replacement therapy (CRRT) for cardiorenal syndrome, definitive surgical management was undertaken: Intraoperative TEE guidance facilitated VSR repair with concomitant coronary artery bypass grafting (CABG), achieving postoperative hemodynamic stability. Regrettably, the patient suffered sudden respiratory and cardiac arrest in postoperative month 4, and succumbed a few days later. TEE provides indispensable high-resolution characterization of post-infarction intramyocardial dissection and perforation topography, enabling precise surgical navigation for mechanical complications. This case underscores its pivotal role in guiding definitive intervention for high-risk cardiac pathologies.