Successful Management of Post-Infarction Ventricular Septal Rupture: A Case Report

Abstract

Background: Post-infarction ventricular septal rupture (PIVSR) is a rare but severe mechanical complication of myocardial infarction (MI) associated with a high mortality rate. Hemodynamic instability is inevitable both during the progression of the condition while awaiting timely surgical intervention and in the postoperative period. Continuous hemodynamic monitoring can enhance the observation of a patient’s circulatory status, facilitate prompt and targeted interventions, and ultimately improve prognosis.

Case Presentation: A 65-year-old man presented with dyspnea 19 days after the onset of MI. He was referred to our hospital with symptoms of acute heart failure and a grade IV/VI pansystolic murmur audible at the apex. Echocardiography revealed a 14 mm ventricular septal defect at the apical region, accompanied by a left-to-right shunt. The patient was stabilized in the cardiovascular care unit and scheduled for ventricular septal rupture (VSR) closure and coronary artery bypass grafting. The procedure was performed on the 16th day of hospitalization. Postoperatively, the patient developed shock due to bleeding and cardiac tamponade, necessitating 2 redo surgeries. Despite these complications, the patient ultimately survived following extensive stabilization efforts.

Conclusion: Hemodynamic monitoring and stabilization are critical factors in determining the prognosis of patients with PIVSR. Timely diagnosis of postoperative complications that compromise hemodynamics, combined with a collaborative interdisciplinary team approach, can enhance treatment strategies, significantly reduce fatal complications and morbidity, and ultimately improve the patient’s likelihood of survival.