Extremely Late Post-Infarction Ventricular Septal Rupture: A Case Report of Successful Surgical Repair

Diego Davila-Flores; Adriana Gutiérrez-Yllu; Brenda Baltodano-García; Wendy Junes-Gonzales; Renee Montesinos-Segura

doi:10.47487/apcyccv.v7i2.602

Autores/as

Diego Davila-Flores Instituto Nacional Cardiovascular, INCOR-EsSalud, Lima, Perú. https://orcid.org/0000-0001-5084-6547
Adriana Gutiérrez-Yllu Facultad de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú. https://orcid.org/0000-0002-3084-1594
Brenda Baltodano-García Facultad de Medicina, Universidad de San Martín de Porres, Lima, Perú. https://orcid.org/0009-0003-0261-6132
Wendy Junes-Gonzales Instituto Nacional Cardiovascular, INCOR-EsSalud, Lima, Perú. https://orcid.org/0000-0001-5195-8735
Renee Montesinos-Segura Instituto Nacional Cardiovascular, INCOR-EsSalud, Lima, Perú. https://orcid.org/0000-0001-5426-830X

DOI:

https://doi.org/10.47487/apcyccv.v7i2.602

Palabras clave:

ST Elevation Myocardial Infarction, Pseudoaneurysm, Ventricular Septal Rupture, Mitral Regurgitation

Resumen

Mechanical complications of ST-elevation myocardial infarction have become rare in high-income settings due to timely reperfusion. However, they remain more prevalent and carry a high mortality in regions lacking access to early reperfusion. We present a 62-year-old man with inferior STEMI managed conservatively without reperfusion. At four months, he developed progressive dyspnea. One year later, echocardiography revealed a large basal ventricular septal rupture and severe eccentric mitral regurgitation, all absent at discharge. The patient’s transfer to a cardiovascular surgery center was delayed by two years, a consequence of the COVID-19 pandemic. Imaging confirmed an inferobasal left ventricular pseudoaneurysm, basal ventricular septal rupture, severe mitral regurgitation, and a left ventricular ejection fraction of 45%. Right heart catheterization showed a significant left-to-right shunt; coronary angiography revealed multivessel coronary artery disease. He underwent successful surgical repair and remained asymptomatic at the three-year follow-up.

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