Rexha Nderim, Krasniqi Xhevdet, Dervishaj Rexha Agnesa, Bakalli Aurora
Clinic of Cardiology, University Clinical Center of Kosova, Pristina, Kosovo, Albania.
Medical Faculty, University of Prishtina, Pristina, Kosovo, Albania.
Clin Med Insights Case Rep. 2024 Sep 12;17:11795476241281442. doi: 10.1177/11795476241281442. eCollection 2024.
Ventricular septal defect (VSD) represents a severe complication that may manifest after a myocardial infarction (MI), typically occurring between 2 and 7 days later. Due to advancements in reperfusion management, the incidence of VSDs after MI has become very rare, occurring in approximately 0.2% of MIs. The current guidelines recommend urgent post-infarction VSD (PI-VSD) closure. We report a case of a patient with a VSD, which was diagnosed 2.5 years after MI. At the time of acute inferior MI, the patient was managed with primary percutaneous intervention in the culprit artery, and 1 month later coronary artery by-pass grafting (CABG) was completed. Twenty and thirty months after AMI patient presented with ventricular tachycardia (VT). Following the second VT episode patient was hospitalized for further examination. Echocardiography revealed the presence of VSD at the site of inferioseptal wall aneurysm. An ICD was implanted owing to recurrent malignant rhythm disorders. In conclusion, although the PI-VSD might have been overlooked and the patient missed the chance of concomitant CABG and VSD repair, this case has reached a 3-year survival, which appears to be the longest survival recorded in a medically treated patient with PI-VSD.
室间隔缺损（VSD）是心肌梗死（MI）后可能出现的一种严重并发症，通常在梗死后2至7天发生。由于再灌注管理的进步，心肌梗死后室间隔缺损的发生率已变得非常罕见，约占心肌梗死的0.2%。当前指南建议对梗死后室间隔缺损（PI-VSD）进行紧急封堵。我们报告一例室间隔缺损患者，该患者在心肌梗死后2.5年被诊断出。急性下壁心肌梗死时，患者在罪犯血管接受了直接经皮介入治疗，1个月后完成了冠状动脉旁路移植术（CABG）。急性心肌梗死后20个月和30个月，患者出现室性心动过速（VT）。第二次室性心动过速发作后，患者住院进一步检查。超声心动图显示在室下间隔壁瘤部位存在室间隔缺损。由于反复出现恶性心律失常，植入了植入式心律转复除颤器（ICD）。总之，尽管可能忽略了梗死后室间隔缺损，患者错过了同期冠状动脉旁路移植术和室间隔缺损修复的机会，但该病例已存活3年，这似乎是接受药物治疗的梗死后室间隔缺损患者记录到的最长生存期。
