A case of ventricular septal rupture associated with major septal branch occlusion after percutaneous coronary intervention

Abstract

IntroductionRupture of the ventricular septum sometimes occurs as a complication of acute myocardial infarction (AMI). Most patients require surgical intervention because the rupture site can expand abruptly, resulting in sudden hemodynamic collapse [1].We usually observe this complication in the setting of AMI associated with major coronary artery occlusion [2]. However, ventricular septal rupture associated with side branch occlusion due to coronary stenting for stable angina pectoris is uncommon.In this report, we describe a rare case of an elderly man who developed ventricular septal rupture due to major septal branch occlusion during coronary stenting of the left anterior descending artery. Case reportA 67-year-old man presented with jaw discomfort and a temporary loss of consciousness. He initially visited the neurology department and underwent brain computed tomography. Magnetic resonance imaging, carotid ultrasonography, and electroencephalography did not reveal any abnormalities. Therefore, the neurologist consulted our department.We performed coronary computed tomography angiography to investigate ischemic heart disease since the patient was suspected of having multiple coronary vessel stenoses with calcification. Coronary angiography revealed severe segmental stenosis in the proximal right coronary artery (RCA) and diffuse stenotic lesions in the left anterior descending artery (LAD); no collateral flow to A B S T R A C TA 67-year-old man underwent elective percutaneous coronary intervention (PCI) of the left anterior descending artery. The major septal branch became occluded during coronary stenting. The patient developed dyspnea 19 days later. Chest radiography revealed lung congestion and a pleural effusion. Transthoracic echocardiography revealed a basal ventricular septal rupture. Emergency coronary angiography did not reveal any in-stent restenosis, and the major septal branch remained occluded. Therefore, the patient underwent closure of the ventricular septal rupture. The postoperative period was uneventful, and he was discharged 29 days after the operation. Septal branch occlusion due to coronary stenting occasionally occurs during routine PCI for which recanalization is sometimes not attempted. However, this case demonstrates that occluded septal branches, although rare, may cause serious complications. <Learning objective: Rupture of the ventricular septum, a complication of acute myocardial infarction, is usually observed in the setting of acute myocardial infarction associated with major coronary artery occlusion. However, ventricular septal rupture associated with side branch occlusion due to coronary stenting for stable angina pectoris is uncommon. Awareness of this rare complication is useful during routine percutaneous coronary intervention.>