Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China.
Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
BMC Cardiovasc Disord. 2021 Dec 18;21(1):605. doi: 10.1186/s12872-021-02392-w.
Ventricular septal rupture (VSR) is a rare but severe complication of acute myocardial infarction (AMI). For such cases, surgical repair is recommended by major guidelines, but not always possible for such cases.
A 72-year-old man presented to the emergency room. ECG showed the ST-segment was elevated by 2-3 mm in lead II, III, and aVF, with Q-waves. Coronary angiography (CAG) showed multi-vessel disease with a total occlusion of the right coronary artery (RCA) and severe stenosis of the left anterior descending artery (LAD). A diagnosis of acute inferior myocardial infarction was made. VSR occurred immediately after percutaneous coronary intervention (a 2.5 × 20 mm drug-eluting stent implanted in RCA), and the patient developed cardiogenic shock. An intra-aortic balloon pump (IABP) was used to stabilize the hemodynamics. Transthoracic echocardiography (TTE) revealed an 11.4-mm left-to-right shunt in the interventricular septum. An attempt was made to reduce the IABP augmentation ratio for weaning on day 12 but failed. Transcatheter closure was conducted using a 24-mm double-umbrella occluder on day 28. The patient was weaned from IABP on day 31 and underwent secondary PCI for LAD lesions on day 35. The patient was discharged on day 41. Upon the last follow-up 6 years later, CAG and TTE revealed no in-stent restenosis, no left-to-right shunt, and 51% left ventricular ejection fraction.
Prolonged implementation of IABP can be a viable option to allow deferred closure of VSR in AMI patients, and transcatheter closure may be considered as a second choice for the selected senior and vulnerable patients, but the risk is still high.
室间隔破裂（VSR）是急性心肌梗死（AMI）的一种罕见但严重的并发症。对于此类病例，主要指南建议进行手术修复，但并非总是可行。
一名 72 岁男性因胸痛被送至急诊室。心电图显示 II、III 和 aVF 导联的 ST 段抬高 2-3mm，伴有 Q 波。冠状动脉造影（CAG）显示多支血管病变，右冠状动脉（RCA）完全闭塞，左前降支（LAD）严重狭窄。诊断为急性下壁心肌梗死。经皮冠状动脉介入治疗（RCA 植入 2.5×20mm 药物洗脱支架）后立即发生 VSR，患者出现心源性休克。使用主动脉内球囊泵（IABP）稳定血流动力学。经胸超声心动图（TTE）显示室间隔有 11.4mm 的左向右分流。试图在第 12 天减少 IABP 增强比以脱机，但失败。第 28 天使用 24mm 双伞封堵器进行经导管封堵。第 31 天患者成功脱机 IABP，并于第 35 天进行 LAD 病变的二次 PCI。第 41 天患者出院。在 6 年后的最后一次随访中，CAG 和 TTE 显示无支架内再狭窄，无左向右分流，左心室射血分数为 51%。
长时间实施 IABP 可为 AMI 患者延迟 VSR 封堵提供可行的选择，对于选择的高龄和脆弱患者，经导管封堵可作为二线治疗方法，但风险仍然较高。
