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Background: Interventricular septal dissection is a critical disease characterized by the separation of the intraventricular septum into two layers, forming an intermediate layer with a cystic cavity that communicates with the root of the aorta or ventricle. It has low morbidity and high mortality rates. Case presentation: Case 1: A 58-year-old male with a history of hypertension and smoking presented to a local hospital due to chest tightness and pain for 4 days. Coronary angiography revealed diffuse lesions from the proximal to the middle segment of the left circumflex branch, with 80% stenosis at its most severe point, and complete occlusion of the proximal segment of the right coronary artery. A stent was implanted in the middle of the right coronary artery. Three months later, the patient was misdiagnosed with an aneurysm of the membranous ventricular septum with defect via echocardiography at the local hospital. After the implantation of a stent in the left circumflex branch, the patient came to our hospital for further diagnosis and treatment. The first ultrasound of our hospital misdiagnosed it as ventricular septal rupture, and a senior ultrasound doctor diagnosed the patient with interventricular septal dissection secondary to myocardial infarction. The patient underwent follow-up echocardiography every 1–2 months for 6 months. The patient remains asymptomatic with stable hemodynamics. The original treatment regimen and follow-up continues. Case 2: A 70-year-old male was admitted to a local hospital due to repeated chest distress for more than 20 years that worsened over several hours. Coronary angiography revealed complete occlusion of the right coronary artery. Cardiogenic shock occurred after percutaneous coronary intervention. The initial several echocardiography of the local hospital and our hospital misdiagnosed it as interventricular septal rupture secondary to myocardial infarction. The later echocardiography diagnosed it as interventricular septal dissection with rupture secondary to myocardial infarction. The patient underwent interventricular septal repair and mitral valvuloplasty after 25 days of medical treatment and died of multiple organ failure on the fourth day after the operation. Conclusions: These two cases illustrate a complication of acute myocardial infarction and highlight the importance of echocardiography in its diagnosis. By exploring the etiology, pathogenesis, and key diagnostic points of IVSD, this study aims to provide valuable insights for clinical practice. [ABSTRACT FROM AUTHOR]

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Introduction: Although the incidence of Acute Coronary Syndrome (ACS) is lower in women, outcomes are worse, particularly in diabetic females. Despite advances in revascularisation and treatment, mortality rates among diabetic females remain higher, with poorer postpercutaneous coronary intervention outcomes. Studies have rarely addressed the differences in the course of myocardial infarction in diabetic females and this underrepresentation has influenced the formulation of guidelines. Aim: To evaluate the in-hospital composite outcomes of death, non fatal myocardial infarction, emergency revascularisation, heart failure and cerebrovascular accident in diabetic women presenting with ST Elevation Myocardial Infarction (STEMI), as well as the individual in-hospital outcomes and outcomes at one and three months follow-up. Materials and Methods: This was a prospective single-centre cohort study conducted between November 2017 and October 2018 on 204 patients with STEMI and followed-up for three months. Data were collected from patients using a semistructured questionnaire-based interview, clinical examination, laboratory investigations, echocardiography and angiography. In-hospital outcomes--death, non fatal MI, emergency revascularisation, heart failure and cerebrovascular accident--were studied. Telephonic follow-up was conducted at one and three months. The comparison of variables was carried out using the Independent Student's t-test or Chi-square test, and regression analysis was performed to identify predictors of mortality. Results: The mean age was 64±11 years; 60.3% were hypertensive and 26% had dyslipidaemia. A total of 12.3% were newly diagnosed diabetics. The mean prehospital delay was 201.9±156.8 minutes. Primary angioplasty was performed in 77%, while thrombolysis was done in 16.7%. The composite outcome was observed in 26.3% of the patients, with heart failure occurring in 19%, cardiogenic shock in 27.9% and death in 16.2%. Cerebrovascular accidents were noted in 0.5% and renal dysfunction was present in 13.2%. At one and three months, heart failure occurred in 7.6% and 5.8%, respectively. Among those with in-hospital mortality, a higher proportion had Anterior Wall Myocardial Infarction (AWMI) (p=0.043), were in Killip class>II (p-value <0.0001), and had qRBBB (Right Bundle Branch Block) (p-value <0.0001). They presented later, with higher blood sugar (p-value <0.0001) and creatinine values (p-value=0.009) and had a lower Ejection Fraction (EF) (p-value=0.003). Killip class (OR=16.0), presence of Ventricular Septal Rupture (VSR) (OR=23.4), no-reflow phenomenon (OR=23.4) and development of renal dysfunction (OR=9.0) were identified as predictors of mortality. Conclusion: Despite a high rate of revascularisation and fewer procedure-related complications, outcomes remain grim, with a higher incidence of heart failure, cardiogenic shock, renal dysfunction and mortality. A worse clinical profile, left ventricular dysfunction and renal dysfunction were significant predictors of mortality. [ABSTRACT FROM AUTHOR]

Objective: To share our experience of post infarct closure of ventricular septal rupture in newly established cardiac center. Study Design: Retrospective study. Setting: Department of Cardiac Surgery, Peshawar Institute of Cardiology, Peshawar. Period: Jan 2021 to August 2024. Methods: All VSR repair cases done during this period were included which were 10. Results: A total of 10 cases of surgical repair of VSR were included in the study. 50 % were males. Mean age was 65 years (IQR 14.7). 40 % were diabetic while 80% were hypertensive. 20% patients had thrombolysis while 60% had PPCI. 50 % patients presented with NYHA IV symptoms. 10% patients were in pre operative AKI. 40% were in cardiogenic shock. 10 % had pre operative IABP passed while 50 % were stabilized with preoperative ionotropic support. 90% of VSR were anterior while 10% posterior. Median VSR size was 13.5 mm (IQR 12.2mm). 20 % VSR were multiple. Median time from onset of symptoms to VSR was 4 days (IQR 2.5). Median time from hospital presentation to VSR repair was 15 days (IQR 20.7). Concomitant CABG was performed in 90% cases. Post operative median ICU stay was 4 days (IQR 4.7) while hospital stay was 7 days (IQR 7.2). Residual VSR, pleural effusion, reopening, post Operative AKI, stroke and heart failure each were present in 10% cases. In hospital mortality was 10%. Conclusion: Optimal timing of surgery and preoperative status of patients are important determinant to decrease postoperative complications and mortality. [ABSTRACT FROM AUTHOR]

The mechanical complications postmyocardial infarction are individually uncommon but potentially life-threatening. The simultaneous occurrence of more than one complication in a single patient is rare and presents a significant diagnostic and therapeutic challenge. We present a case of concurrent left ventricular pseudoaneurysm and ventricular septal rupture post a late presentation, inferoposterior myocardial infarction. This case highlights the importance of multimodality imaging in correctly diagnosing and properly guiding the management plan for these complications, which can dramatically impact patient outcomes.

Background: Ventricular septal rupture (VSR) is a mechanical issue that can occur following an acute myocardial infarction (AMI) and has a high mortality rate. It requires a comprehensive, team-based approach for prompt diagnosis and maintaining stable blood flow. While the occurrence of VSR has lessened over the past hundred years and advancements have been made in treatment techniques, the mortality rate within 30 days can still surpass 40 percent. Surgery is the primary treatment method. For patients with stable blood flow, it is generally considered safer to perform surgery 4–6 weeks after the AMI to repair the VSR. However, the timing of surgery for patients with early instability in their blood flow is still a topic of debate. Summary: There is a lack of set criteria and standards to determine the best time for surgery in patients with VSR following an infarction who have unstable blood flow, especially when considering the use of blood circulation support devices and other techniques for maintaining blood flow that are used in clinical settings. Key Messages: This review outlines the features of different mechanical circulatory support devices utilized in treating VSR, along with the current scoring system designed to direct the treatment approach for VSR patients. [ABSTRACT FROM AUTHOR]

Objectives: Post-myocardial infarction ventricular septal rupture (PIVSR) is one of the most severe types of mechanical complications after acute myocardial infarction (AMI) with high mortality and poor prognosis. The risk factors for short-term mortality of patients with PIVSR may be not widely recognized. We aimed to assess the prevalence and short-term mortality risk predictors of PIVSR. Methods: A total of 62 patients with a diagnosis of PIVSR were admitted to three top general public hospitals in Chongqing, China. Clinical characteristics and short-term outcomes of patients with PIVSR were compared. Predictors of PIVSR were assessed using logistic regression analysis. Results: Mean age was 70.7 ± 10.7 years (38.7% female). The overall in-hospital mortality of PIVSR remained high (71%). Most (47/62) of the patients were in Killip class III or IV at the time of rupture diagnosis. Logistic regression analysis revealed that white blood cell count (WBC, OR 1.619, 95% CI 1.172–2.237, P = 0.005), cardiogenic shock (OR 47.706, 95%CI 2.859-795.945, P = 0.007) and left ventricular ejection fraction (LVEF, OR 0.803, 95%CI 0.689–0.936, P = 0.009) were independent risk factors of in-hospital early mortality. The nomogram developed for predicting the risk of short-term mortality showed a robust discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.956 (95%CI 0.912-1.000). Conclusion: The short-term mortality of PIVSR remained high. WBC, cardiogenic shock, and LVEF were the independent predictive factors of short-term mortality. Our nomogram might be used to predict early mortality of patients with PIVSR. [ABSTRACT FROM AUTHOR]

Background: Ventricular septal defect (VSD) is a lethal complication of myocardial infarction. Case presentation: A 67-year-old male who presented with a history of chest pain associated with shock... Physical examination was significant for crepitation in lower lung fields. Echo showed a left ventricular ejection fraction (LVEF) of 30-35% and muscular ventricular septal defects with left to right shunting and elevated pulmonary artery systolic pressure. In a short time, he developed respiratory failure during the hospital course. Our patient had VSD due to acute myocardial infarction (MI). The patient was transferred to another hospital on a ventilator for surgical intervention but died before any procedure. Conclusion: Our case highlights an unfortunate patient with a VSD secondary to myocardial infarction (MI) resulting in Death. [ABSTRACT FROM AUTHOR]

Background: Full median sternotomy is the traditional approach for the treatment of left ventricular aneurysms (LVA) with or without concomitant ventricular septal rupture (VSR). However, it has some disadvantages such as reduced breathing and exercise thoracic stability, which may increase the surgical risk for older or fragile patients. Herein, we report a case of successful minimally invasive bilateral thoracotomy. Patient and method: A 79-year-old male patient visited our center complaining of breathlessness and orthopnea 21 days after an acute myocardial infarction and percutaneous coronary intervention. An LVA (34.7 mm × 44.4 mm) and a VSR with a diameter of 10 mm close to the apex was detected by echocardiography. Bilateral thoracotomy was performed via two incisions: a 3 cm incision at the right 3rd intercostal space for the aortic root and left atrium vent cannula and aortic clamping; a 7 cm incision at the left 5th intercostal space to expose the apex for LVA and VSR repair. The patient was discharged 7 days postoperatively without any complications. Conclusion: LVA with or without VSR can be successfully repaired via bilateral thoracotomy with promising outcomes. Key clinical message: We present a case study detailing the successful implementation of minimally invasive bilateral thoracotomy for the treatment of left ventricular aneurysm with concomitant ventricular septal rupture. [ABSTRACT FROM AUTHOR]

Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare cause of heart attack, which may not receive sufficient attention from patients during post-discharge treatment, especially among those with normal coronary angiography results. Case presentation We present the case of a 65-year-old woman who was readmitted to the hospital with ventricular septal rupture (VSR) complicated by ventricular aneurysm, occurring 2 weeks after myocardial infarction. During the initial admission, coronary angiography revealed normal coronary arteries, leading to a diagnosis of MINOCA. Epicardial coronary vasospasm or coronary embolism was considered as potential causes; however, the patient did not adhere to standardized treatment upon initial discharge. The delayed VSR led to a decline in cardiac function but did not result in severe hemodynamic impairment. Following correction of heart failure with medications, the patient underwent percutaneous VSR repair 19 days after diagnosis and was discharged with a favorable recovery. Conclusions The occurrence of delayed VSR complicated with ventricular aneurysm in patients with MINOCA is rare, highlighting the possibility of serious complications in MINOCA cases. Both cardioprotective therapies and cause-targeted therapies are essential in the management of patients with MINOCA.

In the prethrombolytic era, ventricular septal rupture (VSR) complicated 1%–3% of all acute myocardial infarctions (AMIs). However, since the introduction of reperfusion therapy, the incidence of VSR has decreased, complicating 0.17%–0.31% of AMIs. Despite a reduction in incidence, mortality of patients with VSR remains high (41%–80%). It is important to identify this rare, but lethal complication at the earliest, as it is associated with high morbidity and mortality. Even with early diagnosis, the survival rate is not good. The management of this fatal complication is also a topic of debate. Even after much research, the management of this fatal complication is not standardized. Here, we present a case series of nine patients who developed VSR as a postmyocardial infarction complication and discuss management options for this rare lethal complication. Cases: We present 9 cases of VSR as a postmyocardial infarction complication. Among these nine patients with VSR, three patients underwent surgical repair, whereas 6 were treated conservatively for various reasons. These cases illustrate the challenges confronted in the diagnosis and management of postmyocardial infarction VSR as one of the rare but lethal complications of myocardial infarction. VSR is a rare but fatal complication of myocardial infraction that poses a challenge in diagnosis and management due to its varying presentation. Therefore, increased awareness of key diagnostic features is crucial for the early recognition of this complication and its effective management.

Abstract Ventricular septal rupture (VSR) is a mechanical complication of acute myocardial infarction (AMI), and its mortality has not decreased significantly in recent decades. However, no clinical model has been developed to predict short-term mortality in patients with post-infarction VSR (PIVSR). This study aimed to develop a nomogram to predict the 30-day mortality by using the clinical characteristics of hospitalized patients with PIVSR. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis was used to construct a nomogram by R. The model was evaluated by the area under the curve (AUC), calibration curve and decision curve analysis (DCA). The bootstrap method was used to validate the model internally. As a result, a nomogram was constructed by using six variables, including CRRT, mechanical ventilation, PPCI, WBC, PASP and methods of treatment. The AUC of the prediction model was 0.96 (0.93, 0.98). The prediction model was well calibrated. The DCA showed that if the threshold probability was between 15% and 95%, the nomogram model would provide a net benefit. The well-constructed and evaluated nomogram can be beneficial to clinicians to predict the risk of death within 30 days in patients with PIVSR.

Abstract Aims Due to its low incidence, poor prognosis, and high mortality in the acute phase, the long‐term prognosis of the left ventricular aneurysm (LVA) complicated by ventricular septal rupture (VSR) has received little attention. This study focus on the long‐term prognosis of patients with LVA complicated by relatively stable VSR. Methods and results Over a decade of retrospection, 68 patients with both LVA and VSR were compared with 136 patients with LVA alone after propensity score matching. Patients with both LVA and VSR were further divided into two groups depending on whether pre‐operative intra‐aortic balloon pump (IABP) was used (23 pre‐operative IABP vs. 45 non‐pre‐operative IABP). The primary endpoint was defined as major adverse cardiovascular and cerebrovascular events, a composite endpoint including mortality, myocardial infarction, revascularization, stroke, and heart failure. Patients with both LVA and VSR were generally in a worse condition upon admission compared with those with LVA alone [percentage of patients in New York Heart Association IV: 42.6% (29/68) vs. 11.0% (15/136), P

Abstract Background Following an acute myocardial infarction (AMI), surgery for left ventricular free wall rupture (LVFWR) and ventricular septal rupture (VSR) has a high in-hospital mortality rate, which has not improved significantly over time. Unloading the LV is critical to preventing excessive stress on the repair site and avoiding problems such as bleeding, leaks, patch dehiscence, and recurrence of LVFWR and VSR because the tissue is so fragile. We present two cases of patients who used Impella 5.5 for LV unloading following emergency surgery for AMI mechanical complications. Case presentation A 76-year-old male STEMI patient underwent fibrinolysis of the distal right coronary artery. Three days later, he passed out and went into shock. Echocardiography revealed a cardiac tamponade. We found an oozing-type LVFWR on the posterolateral wall and treated it with a non-suture technique using TachoSil. Before the patient was taken off CPB, Impella 5.5 was inserted into the LV via a 10 mm synthetic graft connected to the right axillary artery. We kept the flow rate above 4.0 to 4.5 L/min until POD 3 to reduce LV wall tension while minimizing pulsatility. On POD 6, we weaned the patient from Impella 5.5. A postoperative cardiac CT scan showed no contrast leakage from the LV. However, a cerebral hemorrhage on POD 4 during heparin administration complicated his hospitalization. Case 2: A diagnosis of cardiogenic shock caused by STEMI occurred in an 84-year-old male patient, who underwent PCI of the LAD with IABP support. Three days after PCI, echocardiography revealed VSR, and the patient underwent emergency VSR repair with two separate patches and BioGlue applied to the suture line between them. Before weaning from CPB, we implanted Impella 5.5 in the LV and added venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for right heart failure. The postoperative echocardiography revealed no residual shunt. Conclusions Patients undergoing emergency surgery for mechanical complications of AMI may find Impella 5.5 to be an effective tool for LV unloading. The use of VA-ECMO in conjunction with Impella may be an effective strategy for managing VSR associated with concurrent right-sided heart failure.

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare cause of heart attack, which may not receive sufficient attention from patients during post-discharge treatment, especially among those with normal coronary angiography results. Case presentation: We present the case of a 65-year-old woman who was readmitted to the hospital with ventricular septal rupture (VSR) complicated by ventricular aneurysm, occurring 2 weeks after myocardial infarction. During the initial admission, coronary angiography revealed normal coronary arteries, leading to a diagnosis of MINOCA. Epicardial coronary vasospasm or coronary embolism was considered as potential causes; however, the patient did not adhere to standardized treatment upon initial discharge. The delayed VSR led to a decline in cardiac function but did not result in severe hemodynamic impairment. Following correction of heart failure with medications, the patient underwent percutaneous VSR repair 19 days after diagnosis and was discharged with a favorable recovery. Conclusions: The occurrence of delayed VSR complicated with ventricular aneurysm in patients with MINOCA is rare, highlighting the possibility of serious complications in MINOCA cases. Both cardioprotective therapies and cause-targeted therapies are essential in the management of patients with MINOCA. [ABSTRACT FROM AUTHOR]

Background: Ventricular septal defect (VSD) is a lethal complication of myocardial infarction. Case presentation: A 67-year-old male who presented with a history of chest pain associated with shock... Physical examination was significant for crepitation in lower lung fields. Echo showed a left ventricular ejection fraction (LVEF) of 30-35% and muscular ventricular septal defects with left to right shunting and elevated pulmonary artery systolic pressure. In a short time, he developed respiratory failure during the hospital course. Our patient had VSD due to acute myocardial infarction (MI). The patient was transferred to another hospital on a ventilator for surgical intervention but died before any procedure. Conclusion: Our case highlights an unfortunate patient with a VSD secondary to myocardial infarction (MI) resulting in Death. [ABSTRACT FROM AUTHOR]

Ventricular septal rupture (VSR) is a mechanical complication of acute myocardial infarction (AMI), and its mortality has not decreased significantly in recent decades. However, no clinical model has been developed to predict short-term mortality in patients with post-infarction VSR (PIVSR). This study aimed to develop a nomogram to predict the 30-day mortality by using the clinical characteristics of hospitalized patients with PIVSR. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis was used to construct a nomogram by R. The model was evaluated by the area under the curve (AUC), calibration curve and decision curve analysis (DCA). The bootstrap method was used to validate the model internally. As a result, a nomogram was constructed by using six variables, including CRRT, mechanical ventilation, PPCI, WBC, PASP and methods of treatment. The AUC of the prediction model was 0.96 (0.93, 0.98). The prediction model was well calibrated. The DCA showed that if the threshold probability was between 15% and 95%, the nomogram model would provide a net benefit. The well-constructed and evaluated nomogram can be beneficial to clinicians to predict the risk of death within 30 days in patients with PIVSR. [ABSTRACT FROM AUTHOR]

Ventricular septal rupture, a formidable complication of acute myocardial infarction (AMI), is linked to significant morbidity and mortality. The clinical manifestation typically involves pronounced hemodynamic compromise necessitating prompt surgical intervention. This report outlines the case of a 60-year-old male presenting with acute heart failure 3 weeks post a presumed AMI. On evaluation, a substantial ventricular septal defect with left-to-right shunt was observed. The patient, although hemodynamically stable with mild symptoms, underwent surgical closure of the defect and coronary artery bypass graft for multivessel coronary artery disease. This case contributes to the literature on the delayed presentation of post-myocardial infarction (MI) ventricular septal rupture, a scenario deviating from the anticipated severe hemodynamic instability given the timing of the MI and the extent of the septal defect. [ABSTRACT FROM AUTHOR]

This article discusses the use of a percutaneous ventricular assist device, specifically the Impella® CP, as a bridge to high-risk combined heart valve surgery. The device provides temporary mechanical circulatory support and can be used as a bridge to transplant, recovery, or another surgical procedure. The case report presented in the article describes a 40-year-old woman with acute cardiac decompensation who underwent mitral valve replacement and tricuspid annuloplasty surgery with the assistance of the Impella CP. The device was successfully implanted and allowed for complete weaning from inotropic support. The patient had a positive recovery and was discharged from the hospital after 30 days. The article suggests that further randomized trials are needed to confirm the usefulness of the Impella CP in high-risk cardiac surgery. [Extracted from the article]

Aims: Due to its low incidence, poor prognosis, and high mortality in the acute phase, the long‐term prognosis of the left ventricular aneurysm (LVA) complicated by ventricular septal rupture (VSR) has received little attention. This study focus on the long‐term prognosis of patients with LVA complicated by relatively stable VSR. Methods and results: Over a decade of retrospection, 68 patients with both LVA and VSR were compared with 136 patients with LVA alone after propensity score matching. Patients with both LVA and VSR were further divided into two groups depending on whether pre‐operative intra‐aortic balloon pump (IABP) was used (23 pre‐operative IABP vs. 45 non‐pre‐operative IABP). The primary endpoint was defined as major adverse cardiovascular and cerebrovascular events, a composite endpoint including mortality, myocardial infarction, revascularization, stroke, and heart failure. Patients with both LVA and VSR were generally in a worse condition upon admission compared with those with LVA alone [percentage of patients in New York Heart Association IV: 42.6% (29/68) vs. 11.0% (15/136), P < 0.001]. Both pre‐operative and post‐operative IABP use rates were significantly higher in patients with both LVA and VSR than in patients with LVA alone [pre‐operative IABP use rates: 33.8% (23/68) vs. 0.74% (1/136), P < 0.001 and post‐operative IABP use rates: 33.8% (23/68) vs. 10.3% (14/136), P < 0.001]. No significant difference was observed in the primary endpoint between patients with both LVA and VSR and those with LVA alone (log‐rank test, P = 0.63, median follow‐up time 63 months). We further investigated the effect of pre‐operative IABP on the long‐term prognosis of patients with both LVA and VSR. Patients who applied pre‐operative IABP had a worse long‐term prognosis than those who did not (log‐rank test, P = 0.0011). Conclusions: The long‐term prognosis of LVA combined with VSR was not inferior than LVA alone after surgery, but poor blood perfusion status was associated with a worse prognosis. [ABSTRACT FROM AUTHOR]

Ventricular septal rupture remains a dreadful complication of acute myocardial infarction. Although less commonly observed than during the prethrombolytic era, the condition remains complex and is often associated with refractory cardiogenic shock and death. Corrective surgery, although superior to medical treatment, has been associated with high perioperative morbidity and mortality. Transcatheter closure techniques are less invasive to surgery and offer a valuable alternative, particularly in patients with cardiogenic shock. In these patients, percutaneous mechanical circulatory support represents a novel opportunity for immediate stabilization and preserved end-organ function. Multimodality imaging can identify favorable septal anatomy for the most appropriate type of repair. The heart team approach will define optimal timing for surgery vs percutaneous repair. Emerging concepts are proposed for a deferred treatment approach, including orthotropic heart transplantation in ideal candidates. Finally, for futile situations, palliative care experts and a medical ethics team will provide the best options for end-of-life clinical decision making. [Display omitted] • The incidence of ventricular septal rupture after acute myocardial infarction has declined, yet there has been little improvement in clinical outcomes. • Corrective surgery and percutaneous septal closure are options for patients with severe hemodynamic derangement. • Collaboration among members of an interdisciplinary heart/shock team can help estimate the chances of viability vs futility, determine the role of mechanical circulatory support, and determine the timing of intervention. [ABSTRACT FROM AUTHOR]

Purpose of Review: Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. Recent Findings: The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. Summary: A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention. [ABSTRACT FROM AUTHOR]

In the prethrombolytic era, ventricular septal rupture (VSR) complicated 1%–3% of all acute myocardial infarctions (AMIs). However, since the introduction of reperfusion therapy, the incidence of VSR has decreased, complicating 0.17%–0.31% of AMIs. Despite a reduction in incidence, mortality of patients with VSR remains high (41%–80%). It is important to identify this rare, but lethal complication at the earliest, as it is associated with high morbidity and mortality. Even with early diagnosis, the survival rate is not good. The management of this fatal complication is also a topic of debate. Even after much research, the management of this fatal complication is not standardized. Here, we present a case series of nine patients who developed VSR as a postmyocardial infarction complication and discuss management options for this rare lethal complication. Cases: We present 9 cases of VSR as a postmyocardial infarction complication. Among these nine patients with VSR, three patients underwent surgical repair, whereas 6 were treated conservatively for various reasons. These cases illustrate the challenges confronted in the diagnosis and management of postmyocardial infarction VSR as one of the rare but lethal complications of myocardial infarction. VSR is a rare but fatal complication of myocardial infraction that poses a challenge in diagnosis and management due to its varying presentation. Therefore, increased awareness of key diagnostic features is crucial for the early recognition of this complication and its effective management. [ABSTRACT FROM AUTHOR]

The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications. [ABSTRACT FROM AUTHOR]

Background: Post-myocardial infarction (MI) ventricular septal perforation (VSP) is a rare but life-threatening complication. Surgical repair is challenging and carries significant risks, particularly in the context of recurrent VSPs. This case study presents a patient with recurrent VSP after initial surgical repair following myocardial infarction. Case presentation: A 65-year-old male were re-administered to our hospital due to recurrent VSP. He was during follow up after undergone emergency VSP closure surgery 2 months earlier, utilizing the bovine double patch technique via left ventriculostomy. The initial VSP was located in the apical part of the interventricular septum, while the recurrent VSP appeared in the upper middle portion of the interventricular septum (Fig. 1). As the previous patch remained intact, the second surgery employed the bovine double patch technique via right ventriculostomy. The patient's condition remained stable without the development of heart failure symptoms. Conclusion: Repairing recurrent VSPs remains a challenge, necessitating the mastery of appropriate approaches to achieve optimal outcomes. Further research and guidelines are required to refine management strategies for recurrent VSPs. [ABSTRACT FROM AUTHOR]

Introduction: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a rare but serious complication often causing cardiogenic shock (CS). The timing of surgery is a difficult problem for surgeons because of high mortality and surgical complexity. We present a case of successful use of extracorporeal membrane oxygenation (ECMO) for maintaining haemodynamic stability preoperative and delaying surgical repair of VSR patient in severe CS. Case report: A 57-year-old man with AMI complicated by severe CS due to an massive VSR. Emergency surgery was considered a too high mortality risk. The patient was implanted with a percutaneous veno-arterial ECMO (VA-ECMO) system as a bridge to surgery for stabilizing general condition. On the 31th day after ECMO implantation, the ventricular septal defect was successfully repaired and weaning from the ECMO. Discussion: This case study illustrates that it may be considered to use long term ECMO preoperative to delayed surgery which leads to higher survival in cases of massive VSR patient after AMI in hemodynamically compromised patients. Still the optimal duration of mechanical circulatory support and the optimal timing for surgery need more research to define. Conclusion: This case indicates the feasibility of preoperative using of a long term VA-ECMO as a bridge to surgical repair of VSR patient after AMI in severe CS. The optimal duration of mechanical circulatory support and the optimal timing for surgery still require further investigation. [ABSTRACT FROM AUTHOR]

We describe a technique to repair ischemic ventricular septal rupture via a left ventriculotomy. It employs a large endoventricular patch as a "lining" over the locally patched septal defect and the free wall defect which is going to be roofed with an external patch. Both defects are then closed in double layers, holding a single continuous patch. The technique enhances the advantage of the left ventriculotomy in the repair and minimizes ventriculotomy-related morbidity. [ABSTRACT FROM AUTHOR]

Background Takotsubo syndrome (TTS) mimics acute coronary syndromes but can lead to serious cardiac complications, emphasizing the need for improved understanding and management. Case summary We describe a TTS case presented with cardiogenic shock due to ventricular septal rupture (VSR). Successful treatment involved mechanical circulatory support followed by VSR surgical closure. Discussion Ventricular septal rupture is the rarest and deadliest complication associated with TTS. Prompt recognition and a multidisciplinary approach are crucial to achieve the best possible outcome. [ABSTRACT FROM AUTHOR]

The article presents a case report of a 55-year-old man who experienced cardiac arrest, cardiogenic shock, and hypoxemia. Topics include the patient's presentation after out-of-hospital cardiac arrest, initial management including defibrillation and intravenous medications, and subsequent complications such as acute respiratory failure and the need for mechanical ventilation and percutaneous left ventricular assist device (LVAD) support.

Background: Ventricular septal rupture (VSR) is a rare but grave complication of acute myocardial infarction (AMI). It is a mechanical complication of myocardial infarction where patients may present either in a compensated state or in cardiogenic shock. The aim of the study is to determine the in-hospital mortality. The study also aims to identify the predictors of outcomes (in-hospital mortality, vasoactive inotrope score (VIS), duration of ICU stay and mechanical ventilation in the postoperative period) and compare the clinical and surgical parameters between survivors and non-survivors. Methods: This is a retrospective study. The data of 90 patients was collected from the medical records and the data comprising of 13 patients who underwent VSR closure by single patch technique, or septal occluder, and those who expired before receiving the treatment, was excluded. The data of 77 patients diagnosed with post-AMI VSR and who underwent surgical closure of VSR by double patch technique was included in this study. Clinical findings and echocardiography parameters were recorded from the perioperative period. The statistical software used was SPSS version 27. The primary outcome was determining the in-hospital mortality. The secondary outcome was identifying the clinical parameters that are significantly more in the non-survivors, and the factors predicting the in-hopsital mortality and morbidity (increased duration of ICU stay, and of mechanical ventilation, postoperative requirement of high doses of vasopressors and inotropes). Subgroup analysis was done to identify the relation of various clinical parameters with the postoperative complications. The factors predicting the in-hospital mortality were illustrated by a forest plot. Results: The mean age of the patients was 60.35 (±9.9) years, 56 (72.7%) were males, and 21 (27.3%) were females. Requirement of mechanical ventilation preoperatively (OR 3.92 [CI 2.91-6.96]), cardiogenic shock at presentation (OR 4 [CI 2.33 – 6.85]), requirement of IABP (OR 2.05 [CI 1.38-3.94]), were predictors of mortality. The apical location of VSR had been favorable for survival. The EUROScore II at presentation correlated with the postoperative VIS (level of significance [LS] 0.0011, R 0.36. The in-hospital mortality in this study was 33.76%. Conclusion: The in-hospital mortality of VSR is 33.76%. Cardiogenic shock at presentation, non-apical site of VSR, preoperative requirement of mechanical ventilation, high VIS preoperatively, perioperative utilization of IABP, prolonged CPB time, postoperative duration of mechanical ventilation, and high postoperative VIS were the factors associated with increased odds of in-hospital mortality.

Lu Tong, Long Wu, Nianguo Dong Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of ChinaCorrespondence: Nianguo Dong, Email dongnianguo@hotmail.comAbstract: Ventricular septal rupture (VSR) after acute myocardial infarction (AMI) is a rare but often fatal complication. Surgery is considered the preferred treatment, although the optimal timing is discussed. The immediate preoperative hemodynamic status significantly impacts postoperative outcomes, making mechanical circulatory support (MCS) devices crucial for perioperative hemodynamic stability. We present the case of a 61-year-old woman with no remarkable cardiological history admitted to our hospital with a diagnosis of AMI and VSR. Due to hemodynamic instability and cardiogenic shock, we utilized an intra-aortic balloon pump (IABP) and an extracorporeal left ventricular assist device (extra-VAD) as a bridge to surgery. After 17 days of IABP support, the patient experienced hemodynamic instability, elevated lactate levels, pulmonary edema, and eventually bedside endotracheal infiltration inventor-assisted breathing. Subsequently, the IABP was removed, and the patient underwent 6 days of extra-VAD therapy, resulting in hemodynamic stability, a decline in lactate levels, and a reduction in pulmonary edema on X-ray. Surgical coronary artery bypass grafting and VSR repair were successfully performed without periprocedural complications, and the patient was subsequently discharged. Extra-VAD is useful for serious cardiogenic shock in patients with VSR after AMI and may be considered a reasonable approach as a bridge to surgery.Keywords: ventricular septal rupture, acute myocardial infarction, extracorporeal left ventricular assist device

Background: The mechanical complications associated with acute myocardial infarction can be fatal. We report a life-saving case of a very elderly patient with consecutive mechanical complications of acute myocardial infarction. Case presentation: A 90-year-old woman was transferred to our hospital for emergency care due to chest pain. She underwent emergency percutaneous coronary intervention of the left anterior descending branch and was diagnosed with acute myocardial infarction and intra-aortic balloon pumping insertion was performed. After returning to the intensive care unit, she experienced chest pain and went into shock. Echocardiography showed left ventricular free wall rupture, and percutaneous cardiopulmonary support was established. Emergency left ventriculoplasty was performed for the left ventricular free wall rupture. A ventricular septal perforation was observed on postoperative day 9, and its closure through right ventriculotomy was performed on postoperative day 10. On the 128th postoperative day, the patient was transferred to the hospital for rehabilitation. Conclusions: A 90-year-old patient with consecutive left ventricular free wall rupture and ventricular septal perforation after acute myocardial infarction was successfully managed with two surgeries. [ABSTRACT FROM AUTHOR]

Background: The current guidelines have discouraged the routine use of intra-aortic balloon pump (IABP) in cardiogenic shock complicating acute coronary syndrome (ACS). Since then, the trend of IABP utilization in ACS has been declining. Nevertheless, the guidelines still preserve the recommendation of IABP use in hemodynamic instability or cardiogenic shock caused by post myocardial infarction (MI) ventricular septal rupture (VSR). Case presentation: A 46-years-old diabetic Southeast Asian female was referred from a peripheral facility with intractable heart failure despite treatment with vasoactive agents and diuretics for five days. The ECG suggested a recent anteroseptal myocardial infarction with normal high-sensitivity troponin-I value. The echocardiography detected a regional wall motion abnormality and a 10 mm wide ventricular septal defect. Invasive coronary angiography revealed a severe two-vessel coronary artery disease. We planned a delayed surgical strategy with preoperative optimization using IABP as a bridge to surgery. IABP implantation followed by significant hemodynamic improvement and rapid resolution of heart failure without any inotrope support. Afterwards, coronary artery bypass grafting (CABG) and VSR surgical repair were performed. We safely removed IABP on the third postoperative day with proper weaning and minimal vasoactive support. Conclusion: We report a case where IABP still provided benefits for a patient with intractable heart failure caused by undetermined onset MI complicated by VSR. The use of IABP in such a case is in accordance with the recommendation of the current guidelines. Several studies showed that IABP use during preoperative optimization in the case of post-MI VSR was associated with survival benefits. [ABSTRACT FROM AUTHOR]

KONAR-MFO (multifunctional occluder) [Lifetech, Shenzhen, China] was first used in humans in 2013 and received the CE mark in May 2018. As name suggest, it can be use in various(multifunctional) situations in paediatric as well as adults. This is a versatile device with an improved delivery and flexibility which make this device a better option to be use with more comfort and minimum complications. This paper is regarding few rare and complicated lesions, like anomalous origin of coronary artery from pulmonary artery (ALCAPA) device closure, device closure of ventricular septal rupture (VSR) post myocardial infarction in sick elderly and finally device closure of paravalvar leak (PVL)after mitral valve replacement which were treated with this device with excellent results. This study is a retrospective review from a tertiary level dedicated cardiac referral centre in south India. Three cases we are reporting here in which Konar-multifunctional occluders were used in locations other than commoner and regular defects like patent ductus arteriosus, ventricular septal defect etc, over the span of one year between April 2022 and March 2023. Pre-procedure, all patients underwent detailed clinical evaluation followed by transthoracic echocardiography, 12-lead electrocardiogram, and Chest X-ray at the outpatient department. All patients were either symptomatic or had a hemodynamically significant lesion on echocardiography. The decision for transcatheter management was taken after discussing with surgical team in view of either high risk surgery or refusal from patients for surgical options. All patients were followed up post procedure at regular intervals with transthoracic echocardiograms and 12-lead electrocardiograms for a minimum period of 6 months. All these three cases mentioned in our study underwent a complete closure of their respective lesions with no evidence of residual shunt. None of these patients had any major complications, prolonged stay, or any vascular injuries. All patients completed minimum 6-month follow-up and were doing well without any residual flows. First case of ALCAPA, after procedure showed improvement in IVCD, QTc duration and also no significant ischemic changes were noted. Myocardial perfusion scintigraphy was done after 6 months of procedure which showed improvement in contractile function and perfusion of left ventricle. Second case of VSR device closure patient showed immediate significant symptomatic improvement. He was transferred to the coronary care unit, and discharged seven days later. As of now the patient is alive and feeling well with no residual shunt detected by transthoracic echocardiography. No procedure -related complications have been recorded during last two years. Third case of PVL device closure had uneventful recovery from anaesthesia. Prosthetic valve functioned normally during the 5 days of post-procedure hospitalization. The transthoracic 2D- echocardiography performed during follow-up at the end of one month showed no mitral PVL.During follow-up after 1 year, the patient improved symptomatically. Normal prosthetic valve function and no leakage documented on transthoracic echocardiography. Konar-MFO emerging as an important occluder with interesting attributes which makes it a very useful asset to have in catheterizations laboratory. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Ventricular myocardial rupture is a rare complication of myocardial infarction. It occurs within hours to weeks after an infarction. Mortality is high. Antemortem diagnosis is a challenge in low‐resource settings, leading to potential misdiagnosis. Left ventricular myocardial rupture is a potentially fatal yet common complication in acute myocardial infarction patients. Rupture can occur as early as hours after an infarction. However, rupture may also occur later in the first week in the setting of myocardial necrosis and neutrophilic infiltration. Patients may survive several days to weeks before rupture occurs, and cardiac tamponade may present subacutely with a slow or repetitive clinical course. Sudden death can be attributed to ventricular rupture, more commonly during this time frame. Myocardial rupture can also occur as a result of trauma, infections, or cancer. Mortality is exceedingly high if surgical intervention is delayed. In most patients, myocardial rupture manifests as a catastrophic event within days of a first, small, uncomplicated acute myocardial infarction. Acute onset of shortness of breath, chest pain, shock, diaphoresis, unexplained emesis, cool and clammy skin, and syncope may herald the onset of ventricular septal rupture after acute myocardial infarction. Sudden death from myocardial rupture during acute myocardial infarction in patients with no apparent previous symptoms of myocardial ischemia represents a challenge for medical examiners, law enforcement officers, and society as a whole. An autopsy is critical for establishing the cause of death. We present the case of a 54‐year‐old male whose body was found beside the road after a trivial quarrel a day before. Further medical information about the deceased was not available. The preliminary cause of death was presumed to be traumatic. No evidence of trauma was seen during the autopsy. Massive pericardial blood collection compressing the heart and concealed left ventricular myocardial rupture were noted. Histopathological examination of the heart demonstrated myocardial infarction with a tear associated with bleeding that was contained in the pericardial sac. We ruled cardiac tamponade as the cause of death due to an infarcted myocardial rupture. Antemortem diagnosis of myocardial rupture can be challenging in low‐resource settings, leading to potential misdiagnosis and negative impacts such as community conflicts. [ABSTRACT FROM AUTHOR]

The article reports on a case of post-infarction ventricular communication associated with coronary ectasia. The patient, a 55-year-old man with a history of hypertension, presented symptoms of acute heart failure and was diagnosed with an interventricular communication in the mid-septum. Urgent cardiac surgery was performed, but the patient's condition worsened and he died. Coronary ectasia is an anomaly that can cause acute coronary complications and has been associated with atherosclerosis. Pharmacological treatment includes antiplatelet therapy or anticoagulation. The article discusses mechanical complications associated with acute ischemic events, such as papillary muscle rupture, free ventricular wall rupture, and ventricular septal rupture. Although these complications are rare, they remain catastrophic and increase the likelihood of death compared to patients without mechanical complications. The diagnosis of these complications can be challenging, as obstructive coronary disease is often suspected instead of ectatic coronary disease. Post-infarction ventricular communication is a particularly serious complication with a high mortality rate. Surgical repair is the definitive treatment, but it also carries significant risks. [Extracted from the article]

The efficacy and risk of a combination of veno-arterial extracorporeal membrane oxygenation and Impella (Abiomed, Inc., Danvers, MA, USA), an approach known as ECPELLA, for post-infarction cardiac rupture is unclear. We describe the case of a 72-year-old man who presented with acute myocardial infarction. The patient was managed with ECPELLA because of hemodynamic compromise. One week later, there was a sudden increase in venous oxygen saturation. Transthoracic echocardiography revealed ventricular septal rupture, and free wall rupture. Intraventricular thrombus was also observed despite standard anticoagulation therapy. Even with double cardiac rupture, ECPELLA could facilitate left ventricular unloading and sustain hemodynamics. However, because of the risk of device failure due to thrombus aspiration into the Impella, the patient underwent repair surgery. Postoperatively, the patient was temporarily weaned off ECPELLA, and his hemodynamics deteriorated again, and he finally died. ECPELLA can effectively stabilize the hemodynamics in cases of post-infarction cardiac rupture. However, there are still challenges to address, such as determining optimal ventricular reloading and ECPELLA management for intraventricular thrombus prevention. When using ECPELLA to delay surgery for post-infarction cardiac rupture, it is crucial to strike a balance between hemodynamic stabilization and avoiding potential serious complications. [ABSTRACT FROM AUTHOR]

Background: Ventricular septal rupture (VSR) is a rare but grave complication of acute myocardial infarction (AMI). It is a mechanical complication of myocardial infarction where patients may present either in a compensated state or in cardiogenic shock. The aim of the study is to determine the in‑hospital mortality. The study also aims to identify the predictors of outcomes (in‑hospital mortality, vasoactive inotrope score (VIS), duration of ICU stay and mechanical ventilation in the postoperative period) and compare the clinical and surgical parameters between survivors and non‑survivors. Methods: This is a retrospective study. The data of 90 patients was collected from the medical records and the data comprising of 13 patients who underwent VSR closure by single patch technique, or septal occluder, and those who expired before receiving the treatment, was excluded. The data of 77 patients diagnosed with post-AMI VSR and who underwent surgical closure of VSR by double patch technique was included in this study. Clinical findings and echocardiography parameters were recorded from the perioperative period. The statistical software used was SPSS version 27. The primary outcome was determining the in‑hospital mortality. The secondary outcome was identifying the clinical parameters that are significantly more in the non‑survivors, and the factors predicting the in-hopsital mortality and morbidity (increased duration of ICU stay, and of mechanical ventilation, postoperative requirement of high doses of vasopressors and inotropes). Subgroup analysis was done to identify the relation of various clinical parameters with the postoperative complications. The factors predicting the in-hospital mortality were illustrated by a forest plot. Results: The mean age of the patients was 60.35 (±9.9) years, 56 (72.7%) were males, and 21 (27.3%) were females. Requirement of mechanical ventilation preoperatively (OR 3.92 [CI 2.91‑6.96]), cardiogenic shock at presentation (OR 4 [CI 2.33 – 6.85]), requirement of IABP (OR 2.05 [CI 1.38‑3.94]), were predictors of mortality. The apical location of VSR had been favorable for survival. The EUROScore II at presentation correlated with the postoperative VIS (level of significance [LS] 0.0011, R 0.36. The in‑hospital mortality in this study was 33.76%. Conclusion: The in‑hospital mortality of VSR is 33.76%. Cardiogenic shock at presentation, non‑apical site of VSR, preoperative requirement of mechanical ventilation, high VIS preoperatively, perioperative utilization of IABP, prolonged CPB time, postoperative duration of mechanical ventilation, and high postoperative VIS were the factors associated with increased odds of in‑hospital mortality. [ABSTRACT FROM AUTHOR]

Ventricular septal rupture (VSR) is an uncommon but very significant mechanical complication of acute myocardial infarction (AMI), with typically severe hemodynamic effects. Until surgical closure of the defect and revascularization of the coronary bypass surgery graft (CABG), the patient at Wahidin Sudirohusodo Hospital with VSR reports sequelae of MI with stable hemodynamic condition. [ABSTRACT FROM AUTHOR]

Background: An intra-aortic balloon pump (IABP) is the device most frequently used as a bridge to surgical repair in cases of myocardial infarction. However, robust evidence of IABP support for patients with postinfarction ventricular septal rupture (VSR) remains lacking. This study was aimed at assessing the effect of IABP support on 30-day prognosis in patients with acute myocardial infarction (AMI) complicated by VSR. Methods: Retrospective data for patients with VSR after AMI at Fuwai Hospital between April 2002 and August 2020 were analyzed. Patients were initially stratified into two groups according to IABP implantation. The Kaplan-Meier method was used to determine the cumulative incidence of 30-day all-cause mortality. Multivariate logistic regression was used to evaluate the independent risk factors for 30-day mortality. Results: A total of 92 patients (mean age of 67.8 ± 8.3 years; 46.7% male) were included, 59 of whom underwent IABP implantation. Patients with rather than without IABP treatment were younger, were more often male, and had a higher body mass index and lower mean blood pressure at the onset of VSR. At 30 days, all-cause death occurred in 21 patients in the IABP group (35.59%) and 31 patients in the group without IABP (93.94%). After adjustment for age, sex, left atrial diameter, left ventricular diameter, perforation diameter and ventricular aneurysm, IABP support was found to be an independent protective predictor of 30-day all-cause mortality (hazard ratio: 0.22; 95% confidence interval: 0.12 to 0.42; P < 0.001). Conclusions: IABP support was associated with lower 30-day mortality in patients with VSR after AMI. Patients with postinfarction VSR with hemodynamic instability or cardiogenic shock could receive IABP treatment as a bridge to surgical repair. [ABSTRACT FROM AUTHOR]

Ventricular septal rupture (VSR) is a rare and devastating complication of acute myocardial infarction. Early detection, assessment of the hemodynamic impact, and illustration of the pathophysiological context are crucial functions of echocardiography in decision‐making for intensive management and reparative intervention. To evaluate this entity, echocardiography exhibits two strengths: its bedside nature and its multiple modalities. This document reviews the comprehensive use of echocardiography in the study of post‐infarction VSR. [ABSTRACT FROM AUTHOR]

Ventricular septal rupture (VSR) is a catastrophic mechanical complication of acute myocardial infarction (AMI) that can result in acute heart failure. Delaying operative intervention frequently leads to cardiogenic shock and multi-organ failure. Here we report a case of massive anterior MI complicated with VSR that was discovered through cardiac Doppler ultrasound and suspected multiple organ hemorrhage. The patient showed signs of rapid cardiogenic shock and eventually died. The morphological changes of VSR and MI were identified during necropsy, and microscopic examinations of the heart, brain, and kidney revealed multiple organ hemorrhage. This autopsy case suggested that the complication of VSR caused by AMI results in a reduction of oxygen and nutrient content of the circulating blood throughout the body and, eventually, functional failure of multiple organs. We provide clinical and pathological evidence elucidating changes in multiple organs under the severe condition of post-infarction VSR and demonstrate the consequences of a lack of immediate surgery and sufficient medical intervention for a patient suffering from AMI with VSR.