Delayed ventricular septal rupture complicating acute inferior wall myocardial infarction
1 College of Medicine, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA
2 Division of Cardiology, Carle Heart and Vascular Institute, Carle Foundation Hospital, Urbana-Champaign, IL, USA
3 Division of Cardiology, University of Minnesota Medical School, 420 Delaware Street SE, Mayo Mail Code 508, Minneapolis, MN, 55455, USA
BMC Research Notes 2013, 6:124 doi:10.1186/1756-0500-6-124Published: 28 March 2013
Ventricular septal rupture is a potentially fatal complication of acute myocardial infarction. Its incidence has declined with modern reperfusion therapy. In the era of percutaneous coronary interventions, it occurs a median of 18–24 hours after myocardial infarction and is most commonly associated with anterior myocardial infarction. We present a case of delayed ventricular septal rupture complicating acute inferior wall myocardial infarction.
A 53-year-old Caucasian male presented with epigastric pain for three days and electrocardiographic evidence for an acute inferior wall myocardial infarction. Coronary angiography revealed a total occlusion of the proximal right coronary artery. Reperfusion was achieved by balloon angioplasty followed by placement of a bare metal stent. On hospital day six, the patient developed acute respiratory distress, a new loud pansystolic murmur, and hemodynamic instability. Echocardiography revealed the presence of a large defect in the inferobasal interventricular septum with significant left-to-right shunt consistent with ventricular septal rupture. The patient underwent emergent surgical repair with a bovine pericardial patch.
Ventricular septal rupture after myocardial infarction should be suspected in the presence of new physical findings and hemodynamic compromise regardless of revascularization therapy.