Delayed ventricular septal rupture complicating acute inferior wall myocardial infarction

Jae Hyung Cho,Sanjay Mehta,Emil Missov,Srinivasan Sattiraju

doi:10.1186/1756-0500-6-124

Abstract

BackgroundVentricular septal rupture is a potentially fatal complication of acute myocardial infarction. Its incidence has declined with modern reperfusion therapy. In the era of percutaneous coronary interventions, it occurs a median of 18–24 hours after myocardial infarction and is most commonly associated with anterior myocardial infarction. We present a case of delayed ventricular septal rupture complicating acute inferior wall myocardial infarction.Case presentationA 53-year-old Caucasian male presented with epigastric pain for three days and electrocardiographic evidence for an acute inferior wall myocardial infarction. Coronary angiography revealed a total occlusion of the proximal right coronary artery. Reperfusion was achieved by balloon angioplasty followed by placement of a bare metal stent. On hospital day six, the patient developed acute respiratory distress, a new loud pansystolic murmur, and hemodynamic instability. Echocardiography revealed the presence of a large defect in the inferobasal interventricular septum with significant left-to-right shunt consistent with ventricular septal rupture. The patient underwent emergent surgical repair with a bovine pericardial patch.ConclusionVentricular septal rupture after myocardial infarction should be suspected in the presence of new physical findings and hemodynamic compromise regardless of revascularization therapy.

Highlights

Ventricular septal rupture is a potentially fatal complication of acute myocardial infarction
Ventricular septal rupture after myocardial infarction should be suspected in the presence of new physical findings and hemodynamic compromise regardless of revascularization therapy
In the modern era of ubiquitous percutaneous coronary interventions (PCI), Ventricular septal rupture (VSR) has become a rare finding in patients with acute myocardial infarction

Summary

Conclusion

The incidence of VSR has significantly decreased in the modern era of PCI, septal rupture after myocardial infarction should be suspected in the presence of new physical findings and hemodynamic compromise regardless of revascularization therapy. Consent Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Ethical approval is not applicable as this manuscript is not based on experimental research. Competing interests The authors declare that they have no competing interests. Authors’ contributions JHC, SS, SM, and EM contributed to the writing of the manuscript. All authors reviewed and approved the final version of the manuscript. Author details 1College of Medicine, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA. Author details 1College of Medicine, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA. 2Division of Cardiology, Carle Heart and Vascular Institute, Carle Foundation Hospital, Urbana-Champaign, IL, USA. 3Division of Cardiology, University of Minnesota Medical School, 420 Delaware Street SE, Mayo Mail Code 508, Minneapolis, MN 55455, USA

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