Salvage Third-Patch Repair for Left Ventricular Free Wall Rupture After Double-Patch Septal Reconstruction

Ventricular septal perforation (VSP) is a rare but fatal complication of acute myocardial infarction. An 83-year-old man experienced VSP with septal dissection after an anteroseptal infarction. Two weeks later, a double-patch repair using the sandwich technique was performed. Intraoperative residual leakage into the dissected septum caused left ventricular rupture, which was successfully repaired by a third bovine pericardial patch through a left ventricular incision for closure. Postoperative echocardiography confirmed no residual shunt and preserved ventricular function. This case underscores the challenges of VSP with septal dissection and emphasizes the value of an additional patch to prevent leakage and rupture.