AI Article Synopsis
- * A 57-year-old male patient with smoking history experienced AMI complicated by a large VSR and atrial septal defect, but his condition improved post-surgery after successful repair of the septum and ASD closure.
- * The study indicates that VSR following a heart attack may have better surgical outcomes in patients with pre-existing right ventricular overload due to less severe cardiogenic shock at presentation.
Article Abstract
Background: Ventricular septal rupture (VSR) is an uncommon but potentially fatal complication of acute myocardial infarction (AMI). The management of VSR is challenging, and its surgical correction is associated with the highest mortality among all cardiac surgery procedures.
Case Summary: A 57-year-old man with a history of smoking presented with AMI with a large apical VSR in addition to a large secundum atrial septal defect (ASD). His left ventricular ejection fraction was 30%, and the right ventricle was moderately dilated with normal systolic function. Cardiac catheterization revealed that the left anterior descending artery was diffusely diseased with total mid occlusion, whereas other coronary arteries had non-obstructive disease. This unique combination resulted in distinctive presentation with paradoxically better outcomes. After stabilization, the patient's interventricular septum was reconstructed, and the ASD was closed with a pericardial patch. The post-operative period was uneventful, and the patient was discharged 1 week after surgery. A follow-up echocardiography revealed no residual shunt.
Discussion: Post-myocardial infarction VSR presents differently in patients with pre-existing right ventricular volume overload. In such cases, the absence of significant cardiogenic shock at presentation may result in better surgical outcomes.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601236 | PMC |
| http://dx.doi.org/10.1093/ehjcr/ytz042 | DOI Listing |
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