Percutaneous Coronary Intervention in Post-Infarction Ventricular Septal Rupture

Abstract

Background: Ventricular septal rupture (VSR) is a fatal mechanical complication following acute myocardial infarction (AMI). The definitive treatment remains surgical repair, however several aspects are still debatable, including the timing of surgery. Patient’s refusal of treatment and lack of medical facilities put other challenges in management of VSR. Case presentation: A-48-year-old male with a history of diabetes mellitus and hypertension came with a late-presentation anterior AMI, and refused the reperfusion therapy. By the third day, he developed VSR and cardiogenic shock. The patient was also against any referral plan for further therapy. Hemodynamic status was optimally controlled with vasopressor and inotropic agents. The patient was discharged with a grade II-III New York Heart Association (NYHA) on the tenth day. In follow up evaluation a week later, the patient presented limb swelling and functional NYHA class III-IV. The patient agreed to received percutaneous coronary intervention (PCI). Drug eluting stent (DES) in left anterior descending (LAD) coronary artery was implanted successfully without defect closure. Follow-up after 12-months revealed no signs or symptoms of decompensated heart failure.
 
 Keywords: ventricular septal rupture; percutaneous coronary intervention; acute myocardial infarction

A new dimension to the STEMI-related mortality risk seen in the COVID-19 pandemic era

“…Delay between electrocardiographic documentation of STEMI and subsequent development of VSR ( Table 2 ). Twenty patients (13 male) belonged to this category [ [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] ]. Their mean age was 66.…”

“…Conversely, in the presence of severe hypotension, the systolic murmur of VSR “may be difficult to identify because turbulent flow across the defect is reduced” [ 61 ], and the same might also be true of the systolic murmur of PMR [ 62 ]. Clinicians should also be especially vigilant for “stepwise” evolution of VSR [ [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] ], whereby a patient with delayed presentation of STEMI initially presents without clinical or echocardiographic stigmata of VSR but subsequently experiences hypotension and/or increasing breathlessness signalling onset of VSR [ [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] ]. The onset of VSR, in such cases, is typically associated with new-onset pansystolic murmur.…”