Emergency Surgical Repair of Post Infarction Ventricular Septal Rupture
Case Report
Abstract
Ventricular septal rupture (VSR) is a life-threatening complication of
trans-mural acute myocardial infarction (MI). Surgical intervention
remains the treatment of choice, but it is still a challenging operation
associated with high mortality (1). VSR is a rare serious complication
of MI. Its incidence has been estimated between 1%¬ - 2% after MI. If
it treated medically the mortality is very high (25% in 1st day, 75%
at 1st week and 90% at 2 months). Patients that survive following
medical treatment usually have clinically poor cardiac function. So, the
result of medical treatment of VSR is disappointing (2). Primary PCI
following MI can be significantly reduced the incidence of mechanical
complications. However, with improving treatment, appropriate management
of mechanical complications remains a cornerstone to avoid low cardiac
output (LCO) and multi organ failure (MOF). Medical treatment has high
failure and mortality rate, and early surgical ventricular septal defect
(VSD) closure is recommended to reverse the hemodynamic deterioration.
However, surgical repair is associated to a high rate of mortality (20%
–40%) even in the more recent reports (3). Transcatheter device
closure of VSR, is an option, however it is generally accepted to be
inadequate. Progressive deterioration in hemodynamic status makes
surgical intervention often the only realistic option (4).