Email updates

Keep up to date with the latest news and content from BMC Research Notes and BioMed Central.

Open Access Case Report

Delayed ventricular septal rupture complicating acute inferior wall myocardial infarction

Jae Hyung Cho1, Srinivasan Sattiraju2, Sanjay Mehta2 and Emil Missov3*

Author Affiliations

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

For all author emails, please log on.

BMC Research Notes 2013, 6:124  doi:10.1186/1756-0500-6-124

Published: 28 March 2013

Abstract

Background

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.

Case presentation

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.

Conclusion

Ventricular septal rupture after myocardial infarction should be suspected in the presence of new physical findings and hemodynamic compromise regardless of revascularization therapy.

Keywords:
Myocardial infarction; Echocardiography; Ventricular septal rupture; Surgery