Successful Emergent Surgical Repair of Post-Myocardial Infarction Ventricular Septal Rupture With Cardiogenic Shock.

BACKGROUND

Post-myocardial infarction (MI) ventricular septal rupture (VSR) is a rare mechanical complication associated with very high mortality, particularly when complicated by cardiogenic shock.

CASE SUMMARY: A 58-year-old woman presented with anterior ST-segment elevation MI after failed thrombolysis, rapidly progressing to cardiogenic shock and cardiac arrest. Coronary angiography revealed proximal left anterior descending artery occlusion and a large mid-septal VSR. Despite refractory shock requiring vasopressors and intra-aortic balloon pump support, emergent surgical repair with bovine pericardial patch closure and concomitant coronary artery bypass grafting was performed. The patient experienced hemodynamic recovery, later requiring cardiac resynchronization therapy pacemaker for advanced atrioventricular block, and was discharged in stable condition.

DISCUSSION: Emergent surgical repair of post-MI VSR may be lifesaving even in extreme clinical scenarios when guided by rapid diagnosis and coordinated multidisciplinary care.

TAKE-HOME MESSAGE: Early recognition and prompt multidisciplinary intervention are critical for survival in catastrophic post-MI VSR.