SHM Converge Scientific Abstract ePoster Gallery-Ventricular Septal Rupture and Intramyocardial Dissection After Myocardial Infarction

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This case report reviews ventricular septal rupture (VSR) after ST-elevation myocardial infarction (STEMI), a rare but highly lethal complication whose incidence has fallen in the PCI era, though mortality remains very high, especially with cardiogenic shock. It summarizes classic rupture patterns (Becker types 1–3), noting that anterior/LAD infarcts tend to cause smaller, simpler defects, while inferior/RCA infarcts more often produce complex, serpiginous ruptures. Treatment options include delayed surgical repair, which has better outcomes when postponed beyond 7 days, and transcatheter septal closure (TSC), which is limited by defect size but can be used as primary, adjunctive, or salvage therapy.<br /><br />The case involves an 86-year-old man with hypertension, COPD, and heavy smoking history who presented with one week of dyspnea and neck pain. He had elevated troponin, BNP, lactate, pulmonary edema, and ECG changes suggesting ischemia. Cardiac catheterization showed 100% RCA occlusion, but revascularization was not possible. In the ICU, echocardiography revealed a 12 mm basal inferoseptal VSR with left-to-right shunting. Because he was not a surgical candidate, TSC was pursued. Cardiac MRI demonstrated intramyocardial dissection (IMD), a rare complication in which rupture is contained within the myocardium while still communicating with the ventricle. Hemodynamic assessment confirmed severe shunting and cardiogenic shock. However, during the procedure, a wire could not be advanced through the defect because the myocardial flap obstructed access, preventing percutaneous closure. The patient was ultimately compassionately extubated.<br /><br />The report highlights the poor prognosis of inferior post-MI VSR complicated by IMD and cardiogenic shock, and emphasizes that both surgical and percutaneous strategies can be limited by anatomy and critical illness.

Asset Subtitle

Jessica Y. Huang

Meta Tag

Author List Andrew Chen, Benjamin Rosenfeld, Christian Nagy, Federico Mordini, Jeffery Turley, Jessica Y. Huang, Michael Bourne

Category Clinical Vignettes

Concept Post-Myocardial Infarction Ventricular Septal Rupture

Concept Becker Classification

Concept Delayed Surgical Repair

Concept Transcatheter Septal Closure

Concept Intramyocardial Dissection

Distinguished Non-Finalist

Presenter Organization George Washington University

Presenting Author Jessica Y. Huang

Track Adult

Keywords

ventricular septal rupture

ST-elevation myocardial infarction

cardiogenic shock

transcatheter septal closure

intramyocardial dissection

inferior myocardial infarction

right coronary artery occlusion

Becker classification

echocardiography

cardiac MRI

Post-Myocardial Infarction Ventricular Septal Rupture

Becker Classification

Delayed Surgical Repair

Transcatheter Septal Closure

Intramyocardial Dissection