Report an error   
Advanced Search

Ventricular septal rupture after acute myocardial infarction: A report of two cases.


Florante M. Munoz ,
Elson G. Sedilla ,
Napoleon Victoriano ,
Jose A. Yulde

Related Institution

Department of Echocardiography and Doppler, Heart Institute - St. Luke's Medical Center

Publication Information

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Journal of Cardiology
Publication Date
July-September 1993


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.


1. Cercek, B , Shah, P . "Complicated acute myocardial infarction: Heart Failure, Shock, Mechanical Complications" Cardiol Clinics 9(4): 569, 1991
2. Teo, WS , Tong, MC , Quek, MC , Tan, AT , Ong, KK . "Ventricular septal rupture in acute myocardial infarction " Ann Acad Med 19(1): 15, 1990
3. Mann, JM , Roberts, WI . "Acquired ventricular septal defect during acute myocardial infarction: analysis of 38 unoperated necropsy patients and comparison with 50 unoperated necropsy patients without rupture" Am J Cardiol 62(1): 8, 1988
4. Cummings, RG , Reimer, KA , Kaliff, R , Hackel, D , Boswick, J , Lowe, JE . "Quantitative analysis of right and left ventricular infarction in the presence of post-infarction ventricular septal defect " Circ 77(1): 33, 1988
5. Radford, MJ , Johnson, RA , Daggett, WM , Fallon, JT , Buckley, MJ , Gold, HK , Leinbach, RC . "Ventricular septal rupture: a review of clinical and physiologic features and analysis of survival" Circ 64(3): 545, 1981
6. Feneley, MP , Chang, VP , ORourke, MF . "Myocardial rupture after acute myocardial infarction: ten year review" Br Heart J 49, 550, 1983
7. Montoya, A , McKeuer, L , Scanion, P , Sullivan, HJ , Gunnar, R , Pifarré, R . "Early repair of ventricular septal rupture after infarction" Am J Cardiol 45, 345, 1988
8. Casella, G , Ippolito, F , Turinetto, B , Magnani, B . "Post infarction ruprure of interventricular septum: evaluationof the main clinical parameters and post operative survival" G Ital Cardiol 20(2): 126, 1990
9. Giuliani, ER , Danielson, GK , Pluth, JR , Odyniec, NA , Wallace, RB . "Post infarction ventricular septal rupture: surgical considerations and results" Circ 49, 455, 1974
10. Campion, AC . "Ventricular septal defect after myocardial infarction" AIM 70(2): 251, 1969
11. Estrada-Quintero, T , Uretsky, BF , Murali, S , Hardesty, RL . "Prolonged intra-aortic balloon support for septal rupture after myocardila infarction" Ann Thorac Surg 53(2): 335, 1992
12. Cohn, LH . "Surgical Management of acute and chronic cardiac mechanical complications due to myocardial infarction" Am Heart J 102(6): 1049, 1981
13. Williamson, D , Smith, MC , Giuliani, ER , Lie, JT , Maloney, JD , Pluth, JR . "Prognostic factors in post-myocardial infarction ventricular septal defects" American Journal of Physiology - Heart and Circulatory Physiology 56(3): 59, 1977
14. Matsui, K , Kay, JH , Mendez, M , Zubiate, P , Vanstorm, W , Yokohama, C . "Ventricular septal rupture secondary to myocardial infarction: Clinical approach and surgical results" JAMA 245(15): 1537, 1981
15. Daggett, WM . "Post-infarction ventricular septal defect rupture: retrospective thoughts and historical perspectives" Ann Thorac Surg 50(6): 1006, 1990
16. Landale, DG , Schlappi, JC . "Thirteen year survival with acquired interventricular septal defect after myocardial infarction" Am Heart J 64, 33, 1962

Physical Location

LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Box No. 44 Fulltext pdf (Request Document)

©2022 HERDIN PLUS. All rights reserved. | Contact Us | Keep up to date