Florante M. Munoz , Elson G. Sedilla , Napoleon Victoriano ,
Jose A. Yulde Related Institution
Publication Sub Type
Journal Article, Original
Philippine Journal of Cardiology
Among the complications following myocardial infarction (MI), mechanical defects are not as often encountered (in comparison with electrical disturbances and congestive heart failure), either because of their rare occurrence, or their lack of documentation. These include free wall rupture, pseudoaneurysm, acute mitral regurgitation and ventricular septal rupture This paper reviews to cases of ventricular septal rupture following myocardial infarction, which manifested with both extremes of the disease presentation-that of a relatively benign condition requiring elective repair, and that of a catastrophic course posing a medical dilemma The first case is that of a 50 year-old non-hypertensive, non-diabetic female who was admitted with Acute Anterior Wall MI, Killip I. On the third hospital day, she deteriorated to Killip II, associated with development of a Gr. 4/6 holosystolic murmur at the fourth ICS, LPSB with radiation to the base. 2-D Echo with Doppler a month later disclosed a small apical ventricular septal rupture with L-R shunt, which was missed on initial 2-D Echo (w/o Doppler) during the acute phase, in addition to the regional wall motion abnormalities. Cardiac catheterization and surgical repair with revascularization was delayed to allow infarct healing The second is a 62 year-old non-hypertensive, non-diabetic female who was also admitted for Acute Anterior Wall MI. Three days later, there was recurrence of the chest pain associated with hypotension and a new loud holosystolic murmur at the left parasternal border, confirmed to be a large VSD by 2-D Echo. Patient did not improve even with intra-aortic balloon pumping, prompting emergency coronary angiography with CABG revascularization on the fifth hospital day. Two days post-op, a repeat Echo revealed recurrence of the VSD. Patient died the following day.
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