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BMC Res Notes. 2013 Mar 28;6:124. doi: 10.1186/1756-0500-6-124.

Delayed ventricular septal rupture complicating acute inferior wall myocardial infarction.

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1
College of Medicine, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA.

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.

PMID:
23537320
PMCID:
PMC3620691
DOI:
10.1186/1756-0500-6-124
[Indexed for MEDLINE]
Free PMC Article
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