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Cardiol J 2022 May 17. Epub 2022 May 17.

Department of Cardiology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERCV, Madrid, Spain.

Background: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a dangerous condition. Surgical VSR closure is the definitive therapy, but there is controversy regarding the surgical timing and the bridging therapy between diagnosis and intervention. The objective of this study is to analyze the ideal time of surgical repair and to establish the contribution of mechanical circulatory support (MCS) devices on the prognosis. Read More

G Ital Cardiol (Rome) 2022 Mar;23(3):190-199

Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Olanda - Cardiovascular Research Institute Maastricht, Maastricht, Olanda.

Post-infarction mechanical complications include left ventricular free-wall rupture, ventricular septal rupture, and papillary muscle rupture. With the advent of early reperfusion strategies, including thrombolysis and percutaneous coronary intervention, these events now occur in fewer than 0.3% of patients following acute myocardial infarction. Read More

Heart Fail Rev 2021 Oct 21. Epub 2021 Oct 21.

Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, FL, Weston, USA.

Post-myocardial infarction ventricular septal rupture (MI-VSR) remains a dreadful complication with dismal prognosis. Surgical repair is the primary treatment strategy, whereas the role of heart transplantation (HT) as a primary option in MI-VSR is limited to case reports (CRs). We performed a systematic review of CRs to describe in-hospital mortality, and survival at 6 and 12 months in adult patients with MI-VSR treated with HT as a primary or bailout strategy. Read More

PLoS One 2021 18;16(8):e0256377. Epub 2021 Aug 18.

Department of Cardiothoracic Surgery, Mega Medical Complex Hospital, Rawalpindi, Pakistan.

Background And Objective: The effectiveness of deferred surgical repair of ventricular septal rupture (VSR) post-myocardial infarction (MI) with cardiogenic shock remains limited to case reports. Our study aimed to investigate the outcomes and survival analysis following mechanical circulatory support (MCS) in patients after VSR who develop cardiogenic shock.

Methods: We analyzed 27 patients with post-MI VSR and cardiogenic shock who received deferred surgical repair while stabilized on MCS between January 2018 and March 2020. Read More

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:23247096211031135

University Hospitals Cleveland Medical Center, Cleveland, OH, USA.

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. Read More

Cureus 2021 Jun 4;13(6):e15443. Epub 2021 Jun 4.

Cardiology, Hackensack Meridian Health - Ocean Medical Center, Brick, USA.

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. Read More

Eur Heart J Case Rep 2021 Mar 7;5(3):ytab037. Epub 2021 Mar 7.

Department of Cardiothoracic Surgery, Humanitas Clinical and Research Centre, IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milan, Italy.

Background: Left ventricular (LV) aneurysms complicate anterior myocardial infarctions (MIs) in 8-15% of cases. In case of associated LV dysfunction, rapidly evolving heart failure may follow, and urgent surgery becomes life-saving.

Case Summary: Following an acute anterior MI treated by percutaneous coronary intervention, which resulted in apical hypokinesis, depressed LV function, and moderate mitral regurgitation, a 70-year-old male patient kept in contact with our cardiology department through phone calls. Read More

Eur Rev Med Pharmacol Sci 2021 04;25(8):3296-3299

Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Objective: Ventricular septal defect (VSD) is an uncommon but frequently fatal complication following acute myocardial infarction. In medically treated patients, mortality rates exceed 90%, while the surgical repair is associated with better outcomes, even though optimal surgical timing is still under debate.

Case Report: We present the case of a 78-years-old man with no previous remarkable cardiological history admitted to our Emergency Department with the diagnosis of anterior ST-elevation myocardial infarction and significant reduction of left ventricular ejection fraction. Read More

Eur Heart J Case Rep 2021 Feb 18;5(2):ytaa579. Epub 2021 Feb 18.

Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.

Background: Intramyocardial dissecting haematoma is a rare and potentially life-threatening complication of myocardial infarction (MI). Only a few isolated cases have been reported so far.

Case Summary: We report the case of a patient with a large, obstructing intramyocardial haematoma of the ventricular septum following MI due to plaque rupture of the right coronary artery (RCA) and following successful coronary intervention. Read More

Heart Lung 2021 Mar-Apr;50(2):292-295. Epub 2020 Dec 23.

Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States.

The COVID 19 pandemic resulted in a total reduction in the number of hospitalizations for acute coronary syndromes. A consequence of the delay in coronary revascularization has been the resurgence of structural complications of myocardial infarctions. Ventricular septal rupture (VSR) complicating late presenting acute myocardial infarction (AMI) is associated with high mortality despite advances in both surgical repair and perioperative management. Read More

JAMA Cardiol 2021 03;6(3):341-349

Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Importance: Mechanical complications of acute myocardial infarction include left ventricular free-wall rupture, ventricular septal rupture, papillary muscle rupture, pseudoaneurysm, and true aneurysm. With the introduction of early reperfusion therapies, these complications now occur in fewer than 0.1% of patients following an acute myocardial infarction. Read More

J Card Surg 2021 Jan 22;36(1):392-395. Epub 2020 Nov 22.

Department of Cardiothoracic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.

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. Read More

Am J Cardiovasc Dis 2020 15;10(4):376-381. Epub 2020 Oct 15.

Center for Comprehensive Cardiovascular Care, Saint Louis University Saint Louis, Missouri, USA.

Ventricular septal rupture (VSR) is an uncommon and devastating complication with a high mortality rate due to limited available interventions required by expert hands in a small window of opportunity. Most commonly seen following delayed myocardial infarctions (MI), the rate of VSR has decreased partly from protocol driven reperfusion therapy; however, cases are still present, particularly when diagnosis is delayed. We present a case of a critically ill patient in cardiogenic shock following a large anterolateral wall ST-elevation MI complicated by a large VSR whom was transferred to our academic institution for percutaneous repair. Read More

Interact Cardiovasc Thorac Surg 2020 12;31(6):868-873

Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Urayasu, Japan.

Objectives: The effectiveness of delayed surgery for ventricular septal rupture (VSR) following myocardial infarction (MI) in patients with cardiogenic shock remains unknown. We aimed to investigate the outcomes of delayed surgery following mechanical circulatory support for patients in cardiogenic shock after VSR.

Methods: We reviewed 8 patients with post-MI VSR and cardiogenic shock who underwent delayed surgery at our institution between July 2015 and November 2017. Read More

Ann Card Anaesth 2020 Oct-Dec;23(4):471-476

Department of Pharmacy, Talla Padmavathi College of Pharmacy, Warangal, Telangana, India.

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. Read More

JACC Case Rep 2020 Oct 23;2(12):2013-2015. Epub 2020 Sep 23.

Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan.

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. Read More

Ultrasound 2020 Aug 28;28(3):196-201. Epub 2020 Jan 28.

School of Environment and Science, Griffith University, Brisbane, Australia.

Ventricular septal rupture is a rare and potentially fatal complication of transmural myocardial infarction. Early identification utilising transthoracic echocardiography significantly improves long term outcomes in these patients. We report on a case of a 77-year-old male who presented with signs and symptoms of cardiac failure and a loud systolic murmur. Read More

Kyobu Geka 2020 Feb;73(2):87-91

Department of Cardiovascular Surgery, Japanese Red Cross Nagaoka Hospital, Nagaoka, Japan.

Ventricular septal perforation(VSP) is a catastrophic complication of acute myocardial infarction, and posterior VSP reportedly has worse outcomes. We present a case of a 79-year-old man with posterior VSP following acute myocardial infarction. He underwent percutaneous coronary intervention for acute postero-inferior myocardial infarction due to occlusion of the mid-portion of the right coronary artery. Read More

Eur Heart J Cardiovasc Imaging 2020 10;21(10):1170-1171

Department of Cardiology, General Hospital, Merestraat 80, 9300 Aalst, Belgium.

Heart Vessels 2020 Aug 1;35(8):1060-1069. Epub 2020 Apr 1.

Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan.

Mechanical complications (MCs) following acute myocardial infarction (AMI), such as ventricular septal rupture (VSR), free-wall rupture (FWR), and papillary muscle rupture (PMR), are fatal. However, the risk factors of in-hospital mortality among patients with MCs have not been previously reported in Japan. The purpose of this study was to evaluate the prognostic factors of in-hospital mortality in these patients. Read More

Eur Heart J Case Rep 2019 Dec 4;3(4):1-4. Epub 2019 Oct 4.

Cardiology Department, Geisinger Medical Center, 100 N. Academy Ave., Danville, PA 17822, USA.

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. Read More

Echocardiography 2020 01 16;37(1):124-131. Epub 2019 Dec 16.

Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Intramyocardial dissection (IMD) with ventricular septal rupture (VSR) following myocardial infarction (MI) is a rare subacute form of cardiac rupture. The evidence available in this regard is scarce. We aimed to share our experience and conduct a systematic review of previous cases. Read More

Pol Arch Intern Med 2019 11 17;129(11):830-832. Epub 2019 Sep 17.

Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.

Eur Heart J Case Rep 2019 Jun;3(2)

Department of Cardiology, 251 Air Force General Hospital, Leoforos Kanellopoulou 3, Athens, Greece.

Background: Ventricular septal rupture (VSR) is a rare mechanical complication following acute myocardial infarction, with very high mortality rate. Haemodynamic deterioration and cardiogenic shock is common in such cases. Rarely, however, patients may show only signs of chronic heart failure or be completely asymptomatic. Read More

Cardiovasc Revasc Med 2020 11 7;21(11S):65-68. Epub 2019 Jul 7.

Interventional Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy.

Post myocardial infarction ventricular septal defect (VSD) is a life-threatening complication following ST elevation myocardial infarction (STEMI). Current guidelines recommend the urgent VSD closure for its significant mortality. Despite VSD is generally treated by surgical repair, surgeons often refrain from early surgery due to extremely poor results. Read More

Kyobu Geka 2019 May;72(5):380-383

Department of Thoracic and Cardiovascular Surgery, Hirosaki University, Hirosaki, Japan.

The patient was a 73-year-old woman with ventricular septal rupture following acute myocardial infarction. Morphologically, it was associated with ventricular septal dissection and septal pseudoaneurysm formation. She underwent repair of the septal rupture 12 days after the onset of myocardial infarction. Read More

Korean J Thorac Cardiovasc Surg 2019 Apr 5;52(2):70-77. Epub 2019 Apr 5.

Extracorporeal Perfusion Team, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Extracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock.

Methods: We retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. Read More

Eur Heart J Case Rep 2018 Sep 31;2(3):yty081. Epub 2018 Jul 31.

Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, 4A, Dr J J Nagar, Mogappair, Chennai, India.

Background: Fatal mechanical complications of acute myocardial infarctions include free wall rupture and ventricular septal rupture. If pericardial adhesions wall off a free wall rupture, it may lead to formation of pseudoaneurysms that are characterized by a narrow mouth. Even though pseudoaneurysms are common after myocardial infarctions, they may also occur following surgery, trauma, and infections rarely. Read More

Am J Med Sci 2019 06 31;357(6):519-521. Epub 2019 Jan 31.

Department of Cardiovascular Medicine and.

Clin Case Rep 2019 Feb 9;7(2):397-400. Epub 2019 Jan 9.

Second Department of Cardiology "Evangelismos" General Hospital of Athens Athens Greece.

Mechanical complications of acute myocardial infarction include ventricular septal rupture (VSR), free wall rupture, and ischemic mitral regurgitation. Postinfarction VSR is a rare but serious complication of myocardial infarction. VSR has a lower incidence in the era of new reperfusion therapies. Read More