Ventricular Septal Rupture Complicating Acute Myocardial Infarction

Ventricular septal rupture (VSR) is a rare but devastating complication after acute myocardial infarction (AMI). Its accompanied by a very high mortality rate (97% at 30 days of AMI) [1]. The prognosis is greatly improved by the surgical management. This is a retrospective study of  5 cases of VSR following AMI, operated over a two-year period, between November 2013 and December 2014, in the cardiovascular surgery department of the Mohamed V military hospital in Rabat . Clinical information and echocardiography data as well as surgical results, were collected from patient records. All our patients are male, with an average age of 61.4 ± 4.15 years.

Cardiovascular risk factors are dominated by sex at 100%,smoking; Age; diabetes and dyslipidemia at 60%; and obesity at 20%.Concerning the cardiovascular history: AMI <1 month at 100%, angioplasty at 40%, and thrombolysis at 20%.The functional signs are dominated by dyspnea stage III to IV of the NYHA, with angina pain. For the physical signs, all the patients were on  cardiogenic shock, with systolic murmur over the precordium. At the ECG, there were necrosis sequelae with persistence of the ST elevation in 100% of the patients on extensive anterior territory (40%), antero-septo apical territory (40%) and circumferential territory (20%).The chest X-ray demonstrated a cardio thoracic index at 0.55 ± 0.09 with signs of pulmonary edema in 40% of patients. In all patients, the echocardiography demonstrated muscle and apical VSR with an average diameter of 10 mm and restrictive in 80% of cases. The left ventricle is dilated in all patients (LVTDD at 60.8 mm ± 4.86, LVTSDD  at 50 mm ± 3.2) with EF <40%.At coronary angiography, there was an 80% monotroncular lesion, and a 20% bitronuclar lesion. After stabilization by medical treatment, patients underwent VSR surgical closure, left ventricular aneurysm treatment in 2 patients, and coronary bypass surgery in one patient. The postoperative results were satisfactory in 60% of the cases, with a mortality of 40%.

VSR is a rare and serious mechanical complication. The best treatment is based on surgery with a heavy morbidity and mortality. Hence the value of optimizing the management of the AMI.