Post-Myocardial Ventricular Septal Defect, Risk Factors and Epidemiological Aspects

Introduction and aims: Post-myocardial infarction ventricular septal defect is a rare dreadful complication of myocardial infarction. It usually occurs between the 3rd and 7th day of the infarction. Several risk factors for its occurrence have been identified. The aim of our work is to discuss these different risk factors through clinical cases with a literature review. Material and methods: This is a retrospective study conducted from 2015 to 2021 including 18 consecutive patients with post-myocardial ventricular septal defect presented in either cardiac intensive care unit or cardiac surgery department of Mohammed V Military Teaching Hospital Rabat. All patients had at least a clinical examination, an electrocardiogram, and an echocardiogram showing ventricular septal defect. Surgery was performed at cardiac surgery department. Results: Mean age was 65.2± 26.4 years. There were more men than women in our study (17 males/1 female). Diabetes (55.6%) and smoking (55.6%) were the two predominant cardiovascular risk factors. The average body mass index was 23.7 ± 2.98 kg/m². Anteroseptal was the most observed infarct location (38.9%.) 16 patients presented after 12 hours of pain onset. 2 of them underwent percutaneous intervention and 1 underwent coronary artery bypass graft intervention whereas 15 didn't undergo any revascularisation strategy. The culprit artery was left anterior descending artery in 13 patients. The death rate was 55.6%, 50% before surgery and 50% after surgery. Conclusion: Delayed or absence of coronary reperfusion remains the main risk factor for post-myocardial infarction ventricular septal defect occurrence which explains its frequency decline since reperfusion strategies development.