title: Delayed ventricular septal rupture complicating acute inferior wall myocardial infarction.
abstract: BACKGROUND
  Ventricular septal rupture is a potentially fatal complication of acute myocardial infarction. Its incidence has declined with modern reperfusion therapy. In the era of percutaneous coronary interventions, it occurs a median of 18-24 hours after myocardial infarction and is most commonly associated with anterior myocardial infarction. We present a case of delayed ventricular septal rupture complicating acute inferior wall myocardial infarction.
  
  
  METHODS
  A 53-year-old Caucasian male presented with epigastric pain for three days and electrocardiographic evidence for an acute inferior wall myocardial infarction. Coronary angiography revealed a total occlusion of the proximal right coronary artery. Reperfusion was achieved by balloon angioplasty followed by placement of a bare metal stent. On hospital day six, the patient developed acute respiratory distress, a new loud pansystolic murmur, and hemodynamic instability. Echocardiography revealed the presence of a large defect in the inferobasal interventricular septum with significant left-to-right shunt consistent with ventricular septal rupture. The patient underwent emergent surgical repair with a bovine pericardial patch.
  
  
  CONCLUSIONS
  Ventricular septal rupture after myocardial infarction should be suspected in the presence of new physical findings and hemodynamic compromise regardless of revascularization therapy.
authors.affiliation: College of Medicine, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA.
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Cho
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Sattiraju
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mehta
authors.forename: Emil
authors.initials: E
authors.lastname: Missov
mesh_terms: D000800:Angioplasty, Balloon; D000818:Animals; D002417:Cattle; D017023:Coronary Angiography; D004452:Echocardiography; D006352:Heart Ventricles / Q000473:pathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D015424:Reperfusion; D013997:Time Factors; D018658:Ventricular Septal Rupture / Q000150:complications / Q000175:diagnosis*
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