Why the study?
Myocardial infarction associated ventricular septal rupture is a catastrophic complication with poor outcomes and high mortality rates despite surgical repair.
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Mechanical support devices combined with percutaneous closure can serve as an effective bridge to definitive surgery for ventricular septal rupture after STEMI.
BACKGROUND: Myocardial infarction associated ventricular septal rupture (VSR) is a potentially catastrophic complication. Though surgical repair remains the definitive treatment, outcomes are poor with high mortality rates.Case and Management: We present the case of a 62-year-old male who presented with a delayed STEMI leading to a VSR and cardiogenic shock. His management strategy included early percutaneous VSR closure and use of an intra-aortic balloon pump and inotropes. This served as a bridge to definitive surgical VSR patch repair while allowing hemodynamic stabilization, end-organ recovery, and myocardial tissue stabilization. CONCLUSION: Mechanical support devices such as intra-aortic balloon pump and Impella combined with percutaneous closure options can serve as a bridge to definitive surgery for VSR. This requires rapid mobilization of a multi-disciplinary structural heart team including advanced imagers, structural interventionalists, and surgeons.
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Shakir et al. (2022) studied this question.
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