Jafari Mehrdad, Khani Mohammad, Akbari Tooba, Farahani Elham, Bayat Fariba, Bagheri Abdulhamid, Nasrollahizadeh Amir, Ramezani Pedram, Ebrahimi Pouya, Mandegar Mohammad Hossein
Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Shahid Modarres Hospital, Yadegar Emam Highway- Saadat Abad intersection, Tehran, Iran.
J Cardiothorac Surg. 2025 May 9;20(1):230. doi: 10.1186/s13019-025-03440-8.
In the era of modern techniques for the early diagnosis and revascularization of myocardial infarction, post-myocardial infarction ventricular septal defect is rarely seen. However, this potentially fatal complication of ischemic cardiac events cannot always be detected and diagnosed in a straightforward pattern of practice. This study presents an initially delayed-presented post-infarction ventricular septal defect.
The patient was a 58-year-old white man who presented to the cardiology clinic complaining of moderate exertional dyspnea initiated two months ago and exacerbated by the time. His medical history includes an admission three years prior, where he was diagnosed with COVID-19 pneumonia and a myocardial infarction that was complicated by a ventricular septal defect (VSD) and hemodynamic instability. This condition was managed through urgent surgical revascularization and closure of the defect. Due to his current symptoms, further cardiac investigations were planned. A transthoracic echocardiogram was recommended after detecting a grade 3/6 systolic murmur during the physical examination. The initial assessment using an apical four-chamber TTE appeared normal. However, when performing a modified view with a posterior tilt, a bulging septum was observed, leaning toward the right ventricle. This bulging contained a defect with a left-to-right shunt, identified as a residual defect in the area of the repaired patch, along with a myocardial aneurysm. Due to the inconsequential findings from the echocardiogram study, the patient was scheduled for a follow-up echocardiogram, which showed no changes after six months. Additionally, the patient underwent therapeutic management addressing chronic obstructive pulmonary disease.
Although post-infarction ventricular septal defects are rarely seen in the revascularization era, the COVID-19 era was associated with an increase in the prevalence of this complication. It is important to be vigilant for patients who experienced an index event during that time. This potentially fatal complication can present with new issues following the initial event, such as residual defects. Comprehensive imaging studies are necessary to detect the underlying pathology.
Diagnosing post-infarction ventricular septal defect requires the hypervigilance and precision of the cardiologist, who examines the patient and performs the cardiac imaging. Therefore, comprehensive investigations are crucial in patients with a suspicious history of ischemic cardiac events.
在心肌梗死早期诊断和血运重建的现代技术时代，心肌梗死后室间隔缺损很少见。然而，这种缺血性心脏事件的潜在致命并发症并非总能在常规实践中以直接的方式被检测和诊断出来。本研究报告了一例最初延迟出现的心肌梗死后室间隔缺损病例。
患者为一名58岁白人男性，因两个月前开始出现中度劳力性呼吸困难前来心脏病诊所就诊，且症状逐渐加重。他的病史包括三年前入院，当时被诊断为COVID-19肺炎和心肌梗死，并伴有室间隔缺损（VSD）和血流动力学不稳定。该病情通过紧急手术血运重建和缺损修复得到处理。鉴于他目前的症状，计划进行进一步的心脏检查。在体格检查中发现3/6级收缩期杂音后，建议进行经胸超声心动图检查。最初使用心尖四腔经胸超声心动图（TTE）的评估结果正常。然而，当进行向后倾斜的改良视图检查时，观察到一个向右侧心室凸出的室间隔。该凸出部位存在一个伴有左向右分流的缺损，被确定为修复补片区域的残余缺损，同时还伴有心肌瘤。由于超声心动图检查结果不明显，该患者被安排进行随访超声心动图检查，六个月后结果无变化。此外，该患者接受了针对慢性阻塞性肺疾病的治疗管理。
尽管在血运重建时代心肌梗死后室间隔缺损很少见，但COVID-19时代该并发症的患病率有所增加。对于在那段时间经历过索引事件的患者保持警惕很重要。这种潜在致命并发症在初始事件后可能会出现新问题，如残余缺损。需要进行全面的影像学研究以检测潜在的病理情况。
诊断心肌梗死后室间隔缺损需要心脏病专家在检查患者和进行心脏成像时保持高度警惕和精确判断。因此，对于有可疑缺血性心脏事件病史的患者，全面检查至关重要。
