DOI: 10.36347/sjmcr.2023.v11i12.008

Pages: 2099-2202

Mechanical complications following acute myocardial infarction (MI) are rare and account for <1% of the total cases, with the advent of the newest revascularization methods. Although this low incidence, the mortality rate is high, especially among older patients. A 51 years old female, with a history of diabetes and asthma, was admitted to our cardiac intensive care unit for heart failure symptoms. She was diagnosed about 3 weeks ago, with acute anterior wall MI. She did not undergo any revascularization because of the lack of means and was on optimal medical therapy. Transthoracic echocardiography (TTE) revealed akinesia of the inferior, septal, and lateral wall, and all apical segments with a giant aneurysm of 10mm, and a posterior interventricular rupture with a left-right shunt, with a reduced left ventricular (LV) ejection fraction of 19%. An enhanced computed tomography (CT) scan revealed a ventricular septal (VS) defect with a giant left ventricular aneurysm (LVA), which was connected to the LV posterior wall. Urgent cardiac surgery after a percutaneous cardiac intervention was not realized because of lack of means. The association of VS rupture and LVA, found in our patient, is an extremely rare and highly lethal complication requiring urgent surgical management. Its incidence is between 1% and 2% of MIs. TTE has very high sensitivity and specificity, to provide diagnosis and evaluation of VS rupture and LVA. Color-flow Doppler identifies abnormal flow within the aneurysm and helps to highlight ventricular ruptures as an additional image in the endocardium. CT is fast, provides a clear resolution of the LV, and may be used to demonstrate the complications of infarction. The management of VSD is surgical, with the difficulty of repair from fragile infarcted tissue. Medical therapy should stabilize the hemodynamics and act as a bridge to surgery. The simultaneous presence of a VS rupture and LVA is rare and usually occurs within the MI. However, as shown in ..