Successful Management of Post Infarction Ventricular Septal Rupture

a case report

Abstract

Background: Post Infarction Ventricular Septal Rupture (PIVSR) is a rare condition of mechanical complication of myocardial infarction (MI) with a high mortality rate. Deterioration of hemodynamics is inevitable during both its progression while waiting for a timely surgery and after the surgery itself. Continuous vigilance of hemodynamic may improve hemodynamic status observation, enable timely interventions that target specific problems, and ultimately improve patient prognosis.

Case Illustration: 65-year-old man with dyspnea, following 19 days after onset of MI. He was referred to our hospital with a presentation of acute heart failure, with pansystolic murmur grade IV/VI heard at the apex area. Echocardiogram showed a 14 mm IVS gap at the apex area, with left to right shunt. The patient was then stabilized in the CVCU and planned to undergo VSR closure and CABG. Procedure was done at 16^th day of hospitalization. Post operative period, he developed shock due to bleeding and cardiac tamponade that required him to underwent 2x redo surgery. After tremendous efforts for stabilizing the patient, he ultimately survived.

Conclusions: Hemodynamic monitoring and stabilization play a pivotal role in determining the prognosis in the case of PIVSR. Prompt diagnosis of post-operative complications that deteriorate hemodynamics, along with an interdisciplinary team approach, can improve treatment strategy and significantly reduce fatal complications and morbidity, which ultimately will improve the patient’s chances of survival.

Keywords: Myocardial Infarction, Ventricular Septal Rupture, Hemodynamic