A Rare Complication of Myocardial Infarction: Ventricular Septal Defect

Abstract

Ventricular septal defect (VSD) is a rare but lethal complication of myocardial infarction. We present a case of a 65-year-old male who presented with a history of progressive shortness of breath associated with productive cough. Physical examination was significant for crepitation in both lower lung fields and bilateral lower extremity edema. Chest X-ray revealed bilateral reticular opacities with small bilateral pleural effusions. Polymerase chain reaction (PCR) for COVID was positive. Echo showed a left ventricular ejection fraction (LVEF) of 30-35%, ischemic cardiomyopathy, and muscular ventricular septal defects with left to right shunting and severely elevated pulmonary artery systolic pressure. Overtime during the hospital course, he developed respiratory and fulminant hepatic failure. Our patient had VSD due to an undiagnosed old myocardial infarction (MI). Initially heart failure was compensated and treated with medical management. Later on, he developed respiratory complications related to COVID-19 infection as well as hepatic failure in addition to a cardiomyopathy which made him a poor surgical candidate leading to death.

Post-infarction ventricular septal rupture with a contained right ventricular pseudoaneurysm formation

“… 4,5 It has been shown that post-infarction VSD complicates approximately 1–2% of cases of acute MI. 6,7 VSD occurs an average of 2–3 days after the infarction, but may occur any time in the first 2 weeks. 8 Septal rupture, with interventricular left to right shunt, can lead to right ventricular failure, pulmonary edema until biventricular failure.…”

An Undiagnosed Ventricular Septal Rupture Presenting as New Onset Heart Failure: A Rare Complication of an Anterior Myocardial Infarction

“… 1 VSR typically occurs within 1 week after the initial infarction without reperfusion. 1 2 5 With reperfusion (either thrombolysis or percutaneous coronary intervention), the median time from infarction to rupture is around 24 to 48 hours. 1 2 Although thrombolytic therapy may decrease the size of the infarct, it can also result in hemorrhage into the myocardium, which can accelerate the onset of the rupture.…”

“… 3 Although initially preferred for patients who are poor surgical candidates, percutaneous closure is becoming a more viable and less invasive treatment option for VSR as a definitive strategy or bridge to surgery. 4 5 The timing of surgical or percutaneous intervention remains debatable, with studies suggesting that delaying intervention results in lower mortality rates. 3 5 8 Patients who underwent surgery within 7 days of VSR onset had a 54.1% mortality compared with 18.4% mortality if delayed after 7 days.…”

“… 4 5 The timing of surgical or percutaneous intervention remains debatable, with studies suggesting that delaying intervention results in lower mortality rates. 3 5 8 Patients who underwent surgery within 7 days of VSR onset had a 54.1% mortality compared with 18.4% mortality if delayed after 7 days. 5 Similarly in percutaneous closure, mortality was reduced to 21% in those who underwent intervention after the acute phase (> 2 weeks after diagnosis).…”

A Case of a Ventricular Septal Defect (VSD) Leading to a Left Ventricular Aneurysm

“…Post-MI VSDs are most commonly caused by an occlusion of the left anterior descending artery. However, occlusion of any vessels that provide septal branches, without the presence of collaterals, has the potential to form a VSD [1][2]. Depending on the severity, the lack of perfusion to the interventricular septum during an MI results in tissue destruction and the possible formation of a septal defect [3].…”