Concomitant ventricular septal rupture and left ventricular aneurysm can present as chronic heart failure months after myocardial infarction, and delayed surgical repair can be successfully performed with good outcomes.
Alerts clinicians to rare mechanical complications in refractory HF; leaves open optimal management strategies for combined LV aneurysm and VSR.
BACKGROUND: We report a rare case of concomitant inferior left ventricular aneurysm and ventricular septal rupture in a patient presenting with chronic heart failure. CASE PRESENTATION: An 81-year-old man suffered from congestive heart failure. His symptoms were alleviated by medical management; however, heart failure symptoms continued according to the New York Heart Association Functional Classification III. Ten months after presentation, ventricular septal rupture was diagnosed using echocardiography. The left ventricular aneurysm was also complicated. Surgical repair of the ventricular septal rupture and left ventricular aneurysm was successfully performed. The ventricular septal rupture consisted of multiple holes, and the infarcted myocardium had already progressed to firm, fibrotic scar tissue. We closed the ventricular septal rupture with a small bovine pericardial patch and performed an aneurysmectomy with a liner technique. CONCLUSIONS: Cases of ventricular septal rupture can have various clinical scenarios, and treatment should be optimized for each patient, especially with respect to the timing of surgery.
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Kawamura et al. (2021) studied this question.
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