Ventricular septal rupture complicating acute myocardial infarction

Ventricular septal rupture (VSR) is a rare mechanical complication of acute myocardial infarction (AMI). The main risk factors described are advanced age, female gender, a first episode of AMI and presence of coronary disease. There is suspicion for this condition when clinical evidence shows unexplained deterioration of hemodynamic status following infarction. Imaging studies (echocardiogram and colour Doppler) help confirm the diagnosis of ventricular septal rupture. Regarding management, surgical correction continues to be the mainstay of treatment, as it poses lower mortality in comparison to nonsurgical medical approach. Two cases of VSR are presented, the first one is a female adult patient with multiple comorbidities who developed an acute coronary syndrome of a acute myocardial infarction with an anteroseptal ST segment elevation. Primary angioplasty was performed that evidenced ventricular septal rupture, which was surgically corrected at an early stage. After 24 hours, patient showed left ventricular free wall rupture, which precipitated her death. Second case is a female old patient who presented acute acute coronary syndrome of a acute myocardial infarction without lateral ST segment elevation. Seven days later a ventricular septal rupture was documented, which was corrected at a later stage on the eighth day without associated complications.