Conservative Management of a Ventricular Septal Rupture Following Acute Myocardial Infarction in a Jehovah’s Witness

We report the case of a Jehovah’s Witness who underwent conservative management for a ventricular septal rupture (VSR) following acute myocardial infarction. A 71-year-old woman underwent percutaneous coronary intervention for acute anterior myocardial infarction secondary to occlusion of the left anterior descending artery. Transthoracic echocardiography performed the following day revealed VSR, accompanied by a pulmonary-to-systemic blood flow ratio of 4.21 and a left-to-right shunt fraction of 74.5%. Although surgical repair was indicated, the patient, as a Jehovah’s Witness, refused to receive a blood transfusion on religious grounds and presented with a hemoglobin level of 11 g/dL at the time of VSR diagnosis. Emergency surgery was therefore considered high-risk, and conservative management was instead pursued. Subsequently, she exhibited neither cardiogenic shock nor multiple organ failure and therefore maintained clinical stability. The patient was transferred to another hospital 32 days after the VSR diagnosis and was discharged 8 months thereafter. More than three years have passed since the onset of VSR, with transthoracic echocardiography demonstrating persistent VSR characterized by a pulmonary-to-systemic blood flow ratio of 4.38. Nevertheless, she has exhibited no signs of heart failure and has maintained a favorable clinical course.