DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.011

Pages: 911-915

Aims: The objective is to report a rare case of a double post-infarction mechanical complication (ventricular septal rupture [VSR] and ventricular aneurysm) and to discuss the impact of the restrictive nature of the shunt as well as the surgical "timing paradox" on the patient's survival. Case presentation : A 70-year-old diabetic female patient was admitted on the 8th day of a neglected inferior myocardial infarction (MI), which presented as global heart failure. Transthoracic echocardiography revealed a 7 mm basal inferoseptal VSR, with a restrictive left-to-right shunt (gradient at 4.69 m/s), associated with an inferoseptal ventricular aneurysm. Coronary angiography confirmed the proximal occlusion of the right coronary artery. Following medical stabilization, the patient underwent a delayed surgical strategy including an aneurysmectomy, septal closure using an exclusion technique, and coronary artery bypass grafting (CABG). Discussion: The patient's paradoxical survival up to the 8th day is explained by the anatomical restriction of the shunt and the preservation of the left ventricular ejection fraction. This delayed presentation favored a fibrous consolidation of the rupture margins, facilitating surgical repair and optimizing the postoperative prognosis. Conclusion: Therapeutic success relies on precise echocardiographic diagnosis and a multidisciplinary approach to define the ideal surgical timing to transform the prognosis of these extremely severe complications.