Abstract
BackgroundPost-infarction perforation of the ventricular septum is recognized as a major complication of post-myocardial infarction. However, post-infarction ventricle dissection is seldom reported, as the ventricular shunt often accompanying this condition is a significant cause of cardiogenic shock. We encountered a rare case of ventricular dissection unaccompanied by a shunt, which caused a state of shock.Case presentationA 67-year-old man was diagnosed with acute myocardial infarction with a left ventricular oozing rupture. The occlusion of the left anterior descending artery was aspirated, followed by drainage of the pericardial bleeding and hemostasis of the left ventricle. After 15 h, he presented with sudden cardiogenic shock requiring extra-corporeal membrane oxygenation. The transesophageal echocardiogram showed a left ventricular septal aneurysm. Five days later, he underwent an operation, in which a ventricular septal wall dissection with a tear-forming large pseudoaneurysm was found. The tear was closed with a patch. He was weaned off extra-corporeal membrane oxygenation the next day. Αfter 4 months, he was discharged in a stable condition.ConclusionsRecognizing and identifying the cause of cardiogenic shock after myocardial infarction is crucial to provide the best treatment and surgical approach. Ventricular septal dissection should be considered, in addition to the usual complications, such as possible papillary muscle rupture, cardiac rupture, and perforation of the interventricular septum.
Highlights
Post-infarction perforation of the ventricular septum is recognized as a major complication of postmyocardial infarction
Case presentation A 67-year-old man presenting with chest discomfort and nausea was transferred to the nearby hospital. He was diagnosed with acute myocardial infarction; an intra-aortic balloon pump (IABP) was inserted, and he was taken to the catheter room
The patient could not be weaned from extra-corporeal membrane oxygenation (ECMO), and a transesophageal echocardiogram (TEE) performed 5 days later showed the new onset of a left ventricular septal aneurysm (Fig. 1, Additional file 2: Video S2)
Summary
There have been many reports regarding post-myocardial infarction complications, such as left ventricular rupture, ventricular septal perforation, and papillary muscle rupture [1]. To the best of our knowledge, only one case report described a case of a patient who underwent surgical repair of ventricular dissection unaccompanied by a shunt [7] This type of pathology is different from other types of post-myocardial infarction complications, such as left ventricular aneurysm or pseudoaneurysms, which we encountered frequently. In this case, aneurysmal formation involved a dissected septal wall (referred to as the pseudo-lumen) communicating to the left ventricle. There are few anatomical and clinical reports of septal dissection without shunting from the interventricular septum after myocardial infarction It is extremely rare for a case of ventricular dissection without a shunt to be shocked and successfully repaired surgically. Author details 1 Cardiovascular Surgery Department, Nagoya Tokushukai General Hospital, 2‐52 Kozoji‐cho kita, Kasugai, Aichi 487‐0016, Japan. 2 Cardiovascular Surgery Department, Sendai Tokushukai Hospital, 15 Kagosawa, Izumi‐ku, Sendai, Miyagi 981‐3131, Japan
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