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Left ventricular (LV) pseudoaneurysm is a rare complication after postinfarction repair of ventricular septal rupture (VSR), and surgical treatment of this condition due to mycosis has rarely been reported. We report a rare case of successful surgical treatment of delayed LV pseudoaneurysm related to Candida albicans infection after repair of VSR due to myocardial infarction. A 75-year-old woman was admitted for fever and severe inflammatory reaction. Two and a half years previously, she had undergone postinfarct VSR repair and was treated for mycotic infective endocarditis due to C. albicans. Transthoracic echocardiography and computed tomography revealed a LV pseudoaneurysm (maximum transverse diameter 6.2 cm). The cause of the LV pseudoaneurysm was suspected to be infectious, and broad-spectrum antibiotic treatment was started. Fourteen days after admission, she developed acute abdominal pain and an elevated β-D-glucan level because the LV pseudoaneurysm ruptured. Emergency surgical treatment was performed with antimycotic drug therapy. The LV wall defect was reconstructed using bovine pericardium under cardiopulmonary support. Her postoperative course was good, and she was discharged to home. Echocardiography revealed no recurrence of the LV pseudoaneurysm at 4 months postoperatively. During 1 year of follow-up, the patient had been doing well without any infection or adverse event.

Ventricular septal rupture represents one of the most serious complications after an acute coronary syndrome. Nowadays this condition is rare due to early revascularization, but is still associated with high mortality rate. In this case report, we present an unusual case of a woman suffering an acute myocardial infarction with normal coronary arteries complicated with a ventricular septal rupture, which required surgical correction.

Ventricular septal rupture is a rare yet life threatening complication of acute myocardial infarction. Surgical closure is the treatment of choice however despite surgical intervention mortality remains high. Transcatheter closure of ventricular septal rupture has emerged as a new alternative strategy which is less invasive potentially allowing early hemodynamic stabilization. We report a case of a 60-year-old male with post infarction ventricular septal rupture who was treated with percutaneous closure using an Amplatzer device at Shahid Gangalal National Heart Centre, Nepal.

Postinfarction ventricular septal rupture (VSR) represents a well-known mechanical complication of myocardial infarction, determining cardiogenic shock with high mortality rates. Surgical correction requires significant expertise to avoid cardiac rupture, uncontrollable bleeding, residual shunts, heart failure, and death. In the last year, we observed a substantial increase of VSR at our hospital, related to the delayed presentation of people with acute chest pain to the emergency departments during the coronavirus disease 2019 pandemic. We discuss our innovative triple-layer patch technique in a recent consecutive series of 8 patients. This technique proved effective in all patients, with no residual shunt or cardiac rupture.

Ventricular septal rupture is an extremely rare sequelae of blunt chest trauma, and is mostly diagnosed postmortem. We present a case of a large isolated traumatic ventricular septal rupture after a suicide attempt by jumping from a height of 5 stories, which was successfully treated with surgical closure. (Level of Difficulty: Intermediate.), Central Illustration

In this retrospective observational study, we have examined the incidence, characteristics, and treatment of serious myocardial infarction (MI) -associated mechanical complications (MCs) occurring in Japanese patients in this era of percutaneous coronary intervention (PCI), focusing on frailty, nutrition, and clinical implication of surgery. Included were 883 patients who, having suffered an MI, had been admitted to Nihon University Hospital between January 2013 and April 2020. Fifteen (1.70%) of these patients had suffered a potentially catastrophic MC-ventricular free wall rupture (VFWR, n = 8), ventricular septal rupture (VSR, n = 6), or papillary muscle rupture (PMR, n = 1). Factors associated with the MCs were age, poor nutritional status, a high Killip class, delayed diagnosis of MI, a high lactate concentration, a low thrombolysis in myocardial infarction flow grade, and single-vessel disease. Thirty-day mortality among MC patients was 60% (9/15): 87.5% associated with VFWR, 33.3% associated with VSR and 0% associated with PMR. On adjusted multivariate analysis, occurrence of an MC was independently associated with 30-day mortality. Despite a high surgical risk (EuroSCORE II: 11.8 ± 4.7) with less frailty, 30-day mortality was lower among patients whose MC was treated surgically than among those whose MC was treated conservatively (40.0% versus 100.0%, respectively; P = 0.044).Our data suggest that surgical intervention can save patients with a life-threatening MI-associated MC and should be considered, if they are not particularly frail.

Ventricular septal rupture (VSR) represents a rare complication of acute myocardial infarction, often presenting with cardiogenic shock and associated with high in-hospital mortality despite prompt intervention. Although immediate surgery is recommended for patients who cannot be effectively stabilized, the ideal timing of intervention remains controversial. Mechanical circulatory support (MCS) may allow hemodynamic stabilization and delay definitive treatment even in critical patients. However, the interactions between MCS and VSR pathophysiology as well as potentially related adverse effects remain unclear. A systematic review was performed, from 2000 onward, to identify reports describing MCS types, effects, complications, and outcomes in the pre-operative VSR-related setting. One hundred eleven studies (2,440 patients) were included. Most patients had well-known negative predictors (e.g., cardiogenic shock, inferior infarction). Almost all patients had intra-aortic balloon pumps, with additional MCS adopted in 129 patients (77.5% being venoarterial extracorporeal membrane oxygenation). Mean MCS bridging time was 6 days (range: 0 to 23 days). Inhospital mortality was 50.4%, with the lowest mortality rate in the extracorporeal membrane oxygenation group (29.2%). MCS may enhance hemodynamic stabilization and delayed VSR treatment. However, the actual effects and interaction of the MCS-VSR association should be carefully assessed to avoid further complications or incorrect MCS-VSR coupling. (C) 2021 by the American College of Cardiology Foundation.

A 72-year-old woman presented with exertional dyspnea. Echocardiography revealed severe mitral valve stenosis; therefore, mitral valve replacement was performed using a bioprosthetic valve. However, left ventricular wall rupture occurred following mitral valve replacement. Under re-cardiac arrest, we found a left ventricular tear under the posterior annulus of the mitral valve. We repaired the left ventricular muscle using a bovine pericardial patch and implanted a bioprosthetic valve again. Postoperatively, we implanted an Impella 5.0 heart pump through the right axillary artery to ensure left ventricular wall unloading. Systemic blood flow depended almost completely on mechanical circulatory assistance until postoperative day 3. After the fourth postoperative day, we started weaning the patient from Impella 5.0. Finally, it was completely discontinued on the sixth postoperative day. After that, the patient's condition was stable, and she was discharged 44 days postoperatively. Impella 5.0 is a potentially beneficial device for left ventricular unloading in patients with left ventricular wall rupture following mitral valve replacement.

Background: Ventricular septal rupture (VSR) is a fatal mechanical complication following acute myocardial infarction (AMI). The definitive treatment remains surgical repair, however several aspects are still debatable, including the timing of surgery. Patient’s refusal of treatment and lack of medical facilities put other challenges in management of VSR. Case presentation: A-48-year-old male with a history of diabetes mellitus and hypertension came with a late-presentation anterior AMI, and refused the reperfusion therapy. By the third day, he developed VSR and cardiogenic shock. The patient was also against any referral plan for further therapy. Hemodynamic status was optimally controlled with vasopressor and inotropic agents. The patient was discharged with a grade II-III New York Heart Association (NYHA) on the tenth day. In follow up evaluation a week later, the patient presented limb swelling and functional NYHA class III-IV. The patient agreed to received percutaneous coronary intervention (PCI). Drug eluting stent (DES) in left anterior descending (LAD) coronary artery was implanted successfully without defect closure. Follow-up after 12-months revealed no signs or symptoms of decompensated heart failure. Keywords: ventricular septal rupture; percutaneous coronary intervention; acute myocardial infarction

Introduction Ventricular septal rupture (VSR) is a serious mechanical complication after acute coronary syndrome and is related to high mortality. Even with advances in the management of acute myocardial infarction (AMI) such as reperfusion therapies, complication rates are still high. During quarantine, patients presenting mechanical complications after AMI have increased in our institution. Methods From a retrospective database analysis in our institution between the years 2004 and 2020, we identified 37 cases of VSR after AMI. Four chronic cases were excluded from our analysis. The primary endpoint was to identify baseline characteristics that increased 30-day mortality. Results Among 33 acute cases of VSR, 24 cases were submitted to surgery. The 30-day mortality of the operated patients was 45.8%. From 2004 to 2019 our average number of operations of VSR was 1.9 cases/year with an increase to 4 cases/year in 2020. Diabetes mellitus, age, cardiogenic shock, and use of intra-aortic balloon pump were associated with significantly increased mortality using logistic regression. Conclusion We reported an increased number of mechanical complication cases from April to September 2020, compared to our historical records. Despite therapeutic advances, mortality rates remain high. Although the number of cases is small to conclude that the pandemic was responsible for this augmentation, we believe that it is related to the decreased number of patients seeking medical assistance.

Background: Ventricular septal rupture (VSR) is one of the most serious mechanical complications following acute myocardial infarction (AMI). Although a rare complication, it is associated with significant mortality and morbidity. The purpose of this report was to present a case of VSR following anterior AMI in our hospital. Case Description: A 54-year old Javanese male presented persistent episode of breathlessness and lower limb swelling for the last two days with prior chest pain 7 days ago. Physical examination revealed a grade 3/6 holosystolic murmer loudest over the apex, S3 gallop, rales bibasally of the lung. Electrocardiographic evidence revealed for a recent anterior myocardial infarction. Chest X-Ray showed a cardiomegaly and pulmonary congestion. Transthoracic echocardiography revealed VSR at mid-anteroseptal with estimated length of 8-10 mm, preserved LVEF 51% with mid-apicoseptal akinesis. Multiple readmissions were noted for this patient in the follow-up with worsened conditions. Discussion: This is a challenging case report since our hospital is an incapable cath-lab sub-district hospital and far from PCI-capable center. It is critical that all patients with AMI have a brief evaluation for mechanical complications such as VSR. All patients who developed hemodynamic instability during AMI should be comprehensively examined for the murmur and any other heart sound that may provide valuable information. Conclusion: Every clinician especially in the low-resource setting should be aware of this potentially fatal mechanical complication as the mortality remains significantly high. Early prompt diagnosis and treatment is the key of achieving an optimal outcome.

Ventricular septal rupture is a life-threatening complication of myocardial infarction, with its surgical repair representing one of the highest risk cardiac procedures. This complex case demonstrates a novel hybrid approach to decrease the interventricular shunt and an early complication that can occur after initial surgical repair, and the vital role of the anesthesiologist to diagnose and guide both percutaneous and surgical interventions. A 65-year-old woman presented in cardiogenic shock after an anterolateral myocardial infarction with a ventricular septal rupture. Initial surgical repair of her ventricular septal defect (VSD) demonstrated no residual shunt by intraoperative transesophageal echo (TEE) evaluation. However, on POD 6, she again developed cardiogenic shock. Emergent transthoracic echo (TTE) showed patch dehiscence. Attempted resuscitation and repair was then done via percutaneous closure with AmplatzerTM PI Muscular VSD Occluder device. Thirty-two thrombogenic coils were placed along with the occlude device in attempt to reduce the residual shunt. After a period of end-organ stabilization, a redo open removal of AmplatzerTM PI Muscular VSD Occluder with coils and VSD patch repair was done a second time. This sequence of repairs demonstrates a hybrid approach to resolve a deadly condition that resulted in a positive patient outcome.

A 74-year-old woman developed inferior myocardial infarction due to right coronary artery occlusion and underwent percutaneous coronary intervention. Two days later, echocardiography revealed ventricular septal rupture, and Impella CP was inserted to avoid emergency surgery. However, the patient's hemodynamics deteriorated rapidly, necessitating additional venoarterial extracorporeal membranous oxygenation support with concomitant Impella support (ECPELLA). The ventricular septal rupture was surgically repaired using the extended sandwich technique via a right ventricular approach; the ascending aorta was clamped with the clampable portion of the Impella. The patient was successfully weaned from the Impella 3 days postsurgery. This case suggests that urgent surgery with ECPELLA support could be a useful option for patients with ventricular septal rupture, even in severe cases wherein emergency surgery is unavoidable.

Ventricular septal ruptures are an uncommon complication following acute myocardial infarction. Operative repair, utilizing a patch for closure of the defect, is the primary treatment modality to achieve hemodynamic stability. The use of an extracellular matrix derived from small intestinal submucosa as a scaffold for tissue repair is becoming increasingly common. Here, we present the case of a 58-year-old female found to have a ventricular septal rupture and posterior left ventricular aneurysm following late presentation after a myocardial infarction that required operative repair with a CorMatrix patch. Upon readmission for dyspnea and poor exercise tolerance several months later, the patch was subsequently found to have near-completely reabsorbed. There is a paucity of long-term outcomes data following the use of CorMatrix for septal defects, with rare reports of such reabsorption. Further study is required to identify the incidence and implications of such findings.

Ventricular septal rupture (VSR) is an uncommon complication of myocardial infarction (MI). The mortality rate of VSR is high. The management of VSR is including the stabilization of the hemodynamic status and surgical closure of the rupture. In spite of the agreement of experts on the necessity of surgical repair, the timing of VSR repair management remains unclear. In this review article, we evaluate the optimal time repair of VSR. To collect the data, Pubmed, EMBASE, and Cochrane Central Registry databases were searched for potentially suitable studies. Search terms were including “Ventricular Septal Rupture”, “Myocardial Infarction”, “Timing”, and “MI”. According to the result of the studies, it seems that the time between VSR detection and its repair is a determining factor in the survival or mortality of patients in post-myocardial infraction VSR. Studies showed that earlier surgical repair in VSR increases the risk of mortality, because in the early phase after MI, infarcted myocardium is very fragile, and it is very difficult surgical repair and increases the risk of recurrent septal defects. The longer time is needed for the heart and different body systems to adapt to the hemodynamic results of the abrupt left to right shunt. It seems that the best time for the operation is after the maturation of VSR with scarring at the edges of the defect. Moreover, in a large number of patients, it is not possible to delay the operation since they are at risk of severe heart failure and organ dysfunction. In these cases operation immediately after diagnosis of VSR is recommended to prevent further hemodynamic deterioration. In hemodynamically compromised patients, it may be considered to use a ventricular assist device, requiring an intra-aortic balloon pump (IABP), or extracorporeal membrane oxygenation (ECMO) preoperative to postpone the operation which leads to higher survival in post-MI-VSD.

A significant concern in current coronavirus disease-2019 (COVID-19) pandemic era is delay in first medical contact in patients with ST-segment elevation myocardial infarction (STEMI), due to reluctance to visit the hospital. We report a case of delayed presentation of STEMI as ventricular septal rupture during the COVID-19 pandemic, a rare presentation in the current age of primary percutaneous coronary intervention. (Level of Difficulty: Beginner.), Graphical abstract, A significant concern in current coronavirus disease 2019 (COVID-19) pandemic era is delay in first medical contact in patients with ST-segment elevation…

The coronavirus 19 pandemic causes heavy strain on the healthcare systems of countries worldwide. During the pandemic, fear of contracting the infection made the patients with cardiovascular complaints refrain from hospital admittance. This resulted in severe mechanical complications of myocardial infarction. In our hospital we had two ventricular septal ruptures (VSR) as a complication of late admitted inferior myocardial infarction. Having two VSR cases within three days was unusual for us due to the decreased incidence of VSR in the primary PCI era. However, two cases is not enough to reach the conclusion that mechanical complications of myocardial infarction increased during the pandemic, similar case reports from different countries and statements of senior interventional cardiologists support this assertion

Ventricular septal rupture (VSR) is one of the fatal complications of myocardial infarction in the percutaneous coronary intervention era. A rapid diagnosis, medical and mechanical support, and surgical intervention are required for recovery and survival. In such a situation, the risk of complications associated with surgery is very high, especially in very elderly patients, in which any therapeutic strategy should be carefully discussed by the heart team. Herein, we describe two cases of VSRs after recent myocardial infarction (RMI) in very elderly patients that required debate regarding whether to perform surgery. The patients included a 93-year-old man and 89-year-old man, both of which were not highly frail before the RMI occurred. In the former case, a conservative strategy was adopted because the risk of surgery was considered, but he did not survive. On the other hand, the latter patient underwent surgery and his life was ultimately saved. Based on these two cases, we concluded that even if the patients are very old, if possible, surgical intervention should be fully considered.

Author(s): Portuguese, Andrew J.; Abdulla, Khaled H.; Vornovitsky, Michael; DeAngelis, John | Abstract: Introduction: Ventricular septal rupture (VSR) is a rare complication of ST-elevation myocardial infarction (STEMI), typically discovered post-revascularization.Case report: We present the first case of VSR detected on point-of-care ultrasound (POCUS) in the emergency department immediately prior to emergent angiography, with management positively affected by this discovery. The VSR was quickly confirmed via right heart catheterization. Subsequently, hemodynamic stability was achieved using an intra-aortic balloon pump. A delayed surgical VSR repair, with concomitant coronary artery bypass grafting, was implemented for definitive management.Conclusion: This case highlights the utility of POCUS in a STEMI patient with a suspected mechanical complication.

Background Different techniques have been described to repair post myocardial infarction ventricular septal rupture (VSR), each method may result in residual shunting, bleeding, and suboptimal left ventricular (LV) performance secondary to change in LV geometry. The aim of this report is to describe early and mid-term results of sandwich technique through right ventricle in five consecutive patients. Case presentation Five consecutive patients (3 women and 2 men) with VSR (mean age 62.8 years, range 51-70) underwent surgical repair for postinfarction ventricular septal rupture by sandwich technique performed through right ventricle from August 2012 to April 2019 in our institute. Reconstruction of the septum was performed by two patches of 0.6 mm Gore-Tex on each side of the septal defect through right ventricular incision, according to the method described by Isoda et al. Coronary artery bypass grafting was performed in two patients. The mean aortic clamp time was 90 min (range, 64 to 157 min). The mean extracorporeal circulation time was 146.6 min (range, 108 to 240 min). Postoperative intensive care unit (ICU) stay averaged 12 days (range, 4-40 days). There was no hospital mortality. No postoperative residual shunting was detected, and no patient needed re-operation for bleeding. Patients have been followed up for a mean of 24.4 months (range, 1 week to 7 years). There was one death seven days after discharge due to arrhythmia (40 days after surgery). Conclusion Sandwich technique through right ventricular approach is simple and extendable to all VSRs irrespective of their locations. Residual shunting and bleeding are negligible or zero. It may be considered as standard of repair for patient with post infarction ventricular septal rupture.

Context: Ventricular septal rupture (VSR) is a dreaded complication following myocardial infarction. Surgical repair of VSR is associated with significant early mortality. Variable outcomes in terms of early mortality and midterm functional status have been reported from different centers. Aims: In our study, we attempt to review the experience of decision making and surgical repair of postinfarction VSR, and to analyze the factors contributing to the early mortality and midterm outcome after repair. Materials and Methods: It is a retrospective study. Data were summarized retrospectively by frequencies and percentages for categorical factors, and means and standard deviations for continuous factors. Multivariate logistic regression, odds ratios, 95% confidence intervals, and P value were calculated for different variables to determine their independent effect on operative mortality. All surviving patients answered the EQ-5D Health Questionnaire. Results: Preoperative renal failure, left ventricular dysfunction (moderate and severe), and Killip class (III and IV) were significantly associated with early mortality after surgery. Small residual ventricular septal defect (VSD) was not found to affect the midterm quality of life. Conclusions: Early surgical repair benefits the patient by preventing early end-organ damage. The renal failure left ventricular dysfunction (moderate and severe) and Killip class (III and IV) adversely affect early outcomes after surgery. Small residual ventricular septal defect (VSD) does not affect the midterm quality of life.

Mechanical complication of acute myocardial infarction, such as left ventricular free-wall or septal rupture, pseudo-aneurysm or true aneurysm, are uncommon but potentially fatal conditions, that require an early diagnosis and management. We describe a case of post-infarction ventricular septal rupture with pseudoaneurysm formation included in the right ventricle.

International audience; Aims: Mechanical complications (MC) (i.e., free wall rupture (FWR), papillary muscle rupture (PMR) and ventricular septal rupture (VSR)) are rare complications of ST- elevation acute myocardial infarction (STEMI). Incidence of MC according to pre-hospital delay remains unknown. We aimed to determine the rates of MC according to pre-hospital delay.Methods: Analysis was conducted on the MODIF registry data. Patients were allocated to four groups according to pre-hospital delay: 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h.Results: 6185 patients with complete data were analyzed. Mean age was 64.1 years old and 75.7% of patients were males. Eighty-three patients (1.34%) presented with MC: 44 (0.71%) experienced a FWR, 17 (0.27%) a PMR, and 22 (0.36%) a VSR. Global rates of MC were 0.82%, 1.43%, 1.24% and 5.07% in the four groups of pre-hospital delays - 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h - respectively (p < 0.001). In-hospital mortality rates were high: 44.2%, 47.1% and 54.6% for FWR, PMR and VSR, respectively. In multivariate analysis, factors independently related to the occurrence of MC were older age, female sex, simultaneous COVID-19 infection, absence of dyslipidemia, initial TIMI flow 0 or 1 in the culprit artery, 36 to 48 h-pre-hospital delay and absence of revascularization by percutaneous coronary intervention (PCI) with stent implantation.Conclusion: The probability of MC in STEMI increases with pre-hospital delay. Mechanical complications of STEMI remain associated with a very poor prognosis.

A 53-year-old man who suffered acute inferior myocardial infarction was recently transferred to our hospital due to occlusion of the right coronary artery. The results of the echocardiogram revealed a basal ventricular septal rupture (VSR). Since hemodynamic instability had been observed, we performed emergency surgery 5 days after the myocardial infarction began. We used a recently developed novel technique to treat this case: a patent ductus arteriosus occluder placed on the left ventricular side of the septum to close the VSR site, placed directly via the transaortic approach. Simple intermittent mattress sutures with gaskets were used for further fixation. The mild residual shunt was detected postoperatively. The patient was discharged 3 weeks after surgery.

This study emphasizes that VSD should not be immediately diagnosed as a congenital disorder; instead, regional wall motion abnormalities in the left ventricle should also be taken into account since it may result from mechanical complications of neglected myocardial infarction.

Graphical abstract, Highlights • Ventricular septal rupture and hemopericardium are rare postinfarction complications. • Contrast[HYPHEN]enhanced echocardiography can help identify pericardial effusion etiologies. • Transcaval percutaneous ventricular assist device implantation is a viable strategy.

During the coronavirus disease 2019 (COVID-19) pandemic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case highlights a potential long-lasting negative effect that the COVID-19 pandemic will have on the care-seeking behavior and health of patients with acute cardiovascular disease.

A multimodality approach in addition to high level of clinical suspicion and thorough physical examination is important in the diagnosis and management of left ventricular aneurysm and rupture after a silent inferior infarction.

This case report demonstrate concurrent of two rare complications of true silent inferior STEMI in the poorly controlled diabetic patient with de-novo heart failure, mimicking congenital VSD.This complication of myocardial infarction often have catastrophic manifestations and the presence of this complications of MI with smooth course is very scarce

Amid the coronavirus disease 2019 (COVID-19) pandemic, there is an unprecedented increase in public avoidance of hospitals predominantly driven by fear of contracting the virus. Recent publications highlight a re-emergence of rare post–myocardial infarction complications. While mechanical complications are infrequent in the era of primary percutaneous coronary intervention, they are associated with high mortality rates. The concurrent occurrence of mechanical complications such as left ventricular aneurysm and ventricular septal rupture is an extremely rare entity. We hereby delineate a unique case of a 53-year-old Caucasian male who underwent successful concomitant closure of a ventricular septal rupture, left ventricular aneurysmectomy, and 3-vessel coronary artery bypass grafting. Due to a delayed initial presentation owing to the patient’s fear of contracting COVID-19, the surgery was carried out 3 months after the myocardial infarction. His postoperative evaluation confirmed normal contractility of the left ventricle and complete closure of the ventricular septal rupture. Six months postoperatively, the patient continues to do well. We also present a literature review of the mechanical complications following delayed presentation of myocardial infarction amid the COVID-19 pandemic. This article illustrates that clinicians should remain cognizant of these extremely rare but potentially lethal collateral effects during the ongoing global public-health challenge. Furthermore, it highlights a significant concern regarding the delay in first medical contact due to the reluctance of patients to visit the hospital during the COVID-19 pandemic.

Ventricular septal rupture (VSR) is a devastating complication of acute myocardial infarction (MI) and is often associated with cardiogenic shock. Although considered to be very rare in the reperfusion era, recent reports have demonstrated an increased frequency of post-MI VSR cases during the COVID-19 pandemic. Despite advances in surgical repair and management strategies over the past decades, mortality rate has remained high, especially in hemodynamically unstable patients. In VSR patients with cardiogenic shock, the use of mechanical circulatory support (MCS) could be used as a bridge to surgical intervention. We report a patient with VSR complicated by cardiogenic shock secondary to late presenting MI, managed successfully with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to surgical intervention.

Background We report a rare case of concomitant inferior left ventricular aneurysm and ventricular septal rupture in a patient presenting with chronic heart failure. Case presentation An 81-year-old man suffered from congestive heart failure. His symptoms were alleviated by medical management; however, heart failure symptoms continued according to the New York Heart Association Functional Classification III. Ten months after presentation, ventricular septal rupture was diagnosed using echocardiography. The left ventricular aneurysm was also complicated. Surgical repair of the ventricular septal rupture and left ventricular aneurysm was successfully performed. The ventricular septal rupture consisted of multiple holes, and the infarcted myocardium had already progressed to firm, fibrotic scar tissue. We closed the ventricular septal rupture with a small bovine pericardial patch and performed an aneurysmectomy with a liner technique. Conclusions Cases of ventricular septal rupture can have various clinical scenarios, and treatment should be optimized for each patient, especially with respect to the timing of surgery.

In this report, we present a case of interventricular septal dissection (IVSD) following inferior wall myocardial infarction (MI) in a 64-year-old patient; the patient ultimately recovered after prompt resuscitation and intervention, despite the high mortality associated with these cases. A 64-year-old male with a history of hypertension and obesity was brought to the hospital following an episode of syncope at home. He had been experiencing chest tightness over the past few days prior to the admission. On physical exam, he had a heart rate of 72 beats per minute and blood pressure of 73/52 mmHg. His electrocardiogram revealed ST-segment elevations in leads II, III, and aVF. Emergent coronary angiography revealed 100% occlusion of the right coronary artery (RCA) with no collateral supply and 95% stenosis of the left anterior descending (LAD) artery. Aspiration thrombectomy and balloon angioplasty and subsequent stenting of the RCA were performed. Transthoracic echocardiogram with color Doppler was performed, which confirmed the presence of a defect in the septum. Color Doppler demonstrated a clear jet entering the ventricular septum from the left ventricle (LV), with the jet traversing the entire length of the septum through a dissection and entering into the right ventricle (RV), consistent with complete IVSD. The patient subsequently underwent a successful bovine pericardial patch repair of the ventricular septum. IVSD is a rare anomaly of the IVS. An echocardiogram is a useful tool to establish the diagnosis. The mortality rate after ventricular septal rupture remains high. Fortunately, our patient had interventricular dissection without rupture. Prompt surgical repair remains the choice of treatment for this condition.

Ventricular septal rupture (VSR) following myocardial infarction is rare in the reperfusion era. The decrease in patients presenting with myocardial infarction during the coronavirus-2019 (COVID-19) pandemic could result in more frequent VSR. This report describes two patients with VSR presenting late after myocardial infarction and treated at a single institution. (Level of Difficulty: Beginner.), Graphical abstract, Ventricular septal rupture (VSR) following myocardial infarction is rare in the reperfusion era. The decrease in patients presenting with myocardial i…

The associated mortality and morbidity of posterior ventricular septal rupture (VSR) is quite high increasing to almost 80% due to severe right ventricle dysfunction and pulmonary artery hypertension. Herein, we present a case of posterior VSR due to inferior wall myocardial infarction who underwent surgery. Premature removal of intra-aortic balloon pump (IABP) led to hemodynamic deterioration and he was salvaged with prolonged and prompt re-institution of IABP. This case also highlights the importance of IABP in right ventricle failure.

Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of acute myocardial infarction. The incidence of VSR has decreased from 1-3% following ST-segment elevation myocardial infarction in the pre-reperfusion era to 0.17-0.31% following primary percutaneous coronary intervention. Survival to 1 month without intervention is 6%. We report a case of a 60-year-old male, admitted in a peripheral hospital with acute anterior wall myocardial Infarction. He was thrombolized with streptokinase. He developed breathlessness at rest and shifted to our hospital for further management. On evaluation in intensive care unit found to have VSR. The patient was in cardiogenic shock. The ventricular septal rupture was successfully closed with a septal occluder device. After which the patient stabilized hemodynamically and was discharged after 8 days.

Background Mechanical complications following myocardial infarction (MI) have decreased in incidence due to the widespread use of early percutaneous coronary revascularization methods. We describe two rare complications as well as their natural history and uncertainties of the ideal management approach. Case summary Sixty-two-year-old female with multiple cardiovascular disease risk factors who had a delayed presentation of ST-segment elevation myocardial infarction and went on to develop dissecting intramyocardial haematoma progressing to ventricular septal rupture and coronary ventricular fistula. Discussion Intramyocardial haematoma is a rare complication of MI. It is considered to be part of the continuum of myocardial rupture which our patient eventually developed in the form of ventricular septal defect. The second rare entity in the same patient was development of a coronary ventricular fistula of the infarct-related stented, artery. The best way of managing dissecting intramyocardial haematoma is unclear with conflicting data between conservative and invasive strategies. Our patient failed the conservative approach as she progressed to frank myocardial rupture.