Division of Cardiac Surgery. Queen's University, Kingston, ON, Canada.
School of Medicine. Queen's University, Kingston, ON, Canada.
Port J Card Thorac Vasc Surg. 2022 Jul 3;29(2):57-58. doi: 10.48729/pjctvs.243.
Ischemic ventricular septal rupture (VSR) is a lethal complication that occurs either after spontaneous or iatrogenic occlusion of one of the major epicardial coronary vessels. To the best of our knowledge, this is the first reported case of a VSD after a septal branch occlusion in a patient with patent coronary artery grafts to both the left anterior descending and posterior descending arteries.
We present a rare case of anterior ischemic VSR due to the occlusion of a major septal branch. The patient had previous coronary artery bypass grafts and his left internal mammary artery conduit to the anterior descending artery was patent. The culprit lesion that resulted in the development of the VSR was the occlusion of a major septal branch.
The presence of collateral circulation in chronic coronary occlusive disease may provide a protective effect against the development of transmural myocardial necrosis which may reduce the risk of septal rupture. This case highlights the fact that patent coronary artery grafts may not protect from future ischemic VSR.
Major septal branches with significant disease should be assessed for percutaneous options if technically feasible as dictated by the Heart Team.
缺血性室间隔破裂（VSR）是一种致命的并发症，发生在自发性或医源性阻塞其中一条主要心外膜冠状动脉后。据我们所知，这是首例报道的在左前降支和后降支冠状动脉旁路移植术后，发生于间隔支阻塞的 VSD 病例。
我们报告了一例罕见的前壁缺血性 VSR，原因是一条主要间隔支闭塞。患者有先前的冠状动脉旁路移植术，他的左内乳动脉到前降支的移植物是通畅的。导致 VSR 发展的罪犯病变是一条主要间隔支闭塞。
慢性冠状动脉闭塞性疾病中的侧支循环的存在可能对透壁性心肌坏死的发展提供一种保护作用，从而降低室间隔破裂的风险。本例强调了一个事实，即通畅的冠状动脉旁路移植术并不能预防未来的缺血性 VSR。
如果技术上可行，心脏团队应评估有显著病变的主要间隔支是否有经皮介入的选择。
