Treatment of acute myocardial infarction complicated by ventricular septal rupture with delayed surgery following intra-aortic balloon pump support: A case report

Abstract

Rationale: – Inferior wall myocardial infarction (MI) complicated by ventricular septal rupture (VSR) is a rare but fatal complication of acute MI. Early surgical intervention is associated with a high mortality rate, and the optimal timing for surgery remains uncertain. This paper presents a case of surgical management of acute inferior wall MI complicated by VSR, with the aim of exploring diagnostic and therapeutic strategies, as well as the timing of surgical intervention. Patient concerns: – A 74-year-old man was admitted to our hospital with chest tightness and tachypnea lasting 3 days. He had no history of hypertension, diabetes mellitus, or hyperlipidemia, denied a family history of coronary heart disease, and had a smoking history of over 30 years. Diagnoses: – Coronary angiography revealed occlusion in the proximal to mid-segment of the right coronary artery, and echocardiography indicated VSR. Interventions: – Surgical treatment was performed after 20 days of intra-aortic balloon pump counterpulsation support. Outcomes: – The patient’s condition improved postoperatively, and he was eventually discharged. Lessons: – VSR is a rare complication of acute MI. Although early surgical intervention is generally preferred, the optimal timing remains ambiguous, and delaying VSR repair may be advantageous. In hemodynamically unstable patients, the use of temporary mechanical circulatory support devices to postpone surgical intervention is advisable.