Battling Right Ventricular Dysfunction in Post-Infarction Ventricular Septal Defect-A Case Report and Comprehensive...

Area of Science:

• Cardiology
• Cardiac Surgery
• Mechanical Complications of Myocardial Infarction

Background:

• Post-infarction ventricular septal defect (VSD) is a rare but lethal mechanical complication of ST-elevation myocardial infarction (STEMI).
• Optimal surgical timing for VSD repair is debated, especially in hemodynamically unstable patients with right ventricular failure.
• Early repair aims to prevent deterioration, while delayed repair allows infarct maturation for better surgical outcomes.

Purpose of the Study:

• To present a case of post-infarction VSD in a patient with STEMI and right ventricular failure.
• To highlight the importance of timely surgical intervention and mechanical circulatory support in managing this critical condition.

Main Methods:

• Case report of a 39-year-old male with inferior STEMI.
• Urgent percutaneous coronary intervention followed by surgical VSD repair due to clinical deterioration.
• Postoperative management included veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock.

Main Results:

• Successful urgent surgical VSD repair was performed.
• The patient required temporary VA-ECMO support for five days due to severe pulmonary hypertension and cardiogenic shock.
• The patient was successfully weaned from support and discharged, with good recovery at follow-up.

Conclusions:

• Timely surgical intervention is crucial for post-infarction VSD, particularly with right ventricular failure.
• Mechanical circulatory support plays a vital role in managing severe postoperative cardiogenic shock.
• This case emphasizes the successful management of a complex post-STEMI complication.