Key result
Surgical exclusion of an apical aneurysm and pericardial patch closure of a 17-mm post-infarction VSD diagnosed 11 months post-MI resolved heart failure symptoms at 2-week follow-up.
Why the study?
Ventricular septal defect is a rare and serious complication of myocardial infarction that usually occurs within the first few days after the acute event, making late presentation unusual.
Case Report (n=1)
No
This case demonstrates that a post-infarction ventricular septal defect can present as late as 11 months after the acute event if a complex, tortuous pseudoaneurysmal anatomy limits the hemodynamic shunt, underscoring the need to evaluate for mechanical complications when a new murmur or unexplained heart failure occurs late post-MI.
Ventricular septal defect (VSD) is a rare and serious complication of myocardial infarction, usually occurring within the first few days after the acute event. We report the case of a 78-year-old woman who sustained an anterior myocardial infarction in June 2024 and underwent percutaneous coronary intervention of the mid left anterior descending artery with drug-eluting stent implantation. In May 2025, nearly eleven months later, she was admitted with recurrent heart failure decompensation. The appearance of a previously absent systolic murmur prompted repeat echocardiography, which revealed a 17-mm muscular septo-apical VSD with a left to right shunt. Transesophageal echocardiography showed a pseudoaneurysm bounded by a membrane and a tortuous course of the defect, an anatomy that may explain the relatively good tolerance of this large defect. Myocardial scintigraphy confirmed septo-apical necrosis. The patient ultimately underwent surgical exclusion of the apical aneurysm and VSD closure with a reinforced pericardial patch. This case shows that a post-infarction VSD may present very late and highlights the importance of considering a mechanical complication when a new murmur or otherwise unexplained heart failure decompensation occurs, even several months after myocardial infarction.
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Nobime et al. (2026) conducted a case report in Post-infarction ventricular septal defect and apical pseudoaneurysm (n=1). Surgical exclusion of the apical ventricular aneurysm and VSD closure with a reinforced pericardial patch was evaluated on Clinical resolution of dyspnea and heart failure decompensation. Surgical exclusion of an apical aneurysm and pericardial patch closure of a 17-mm post-infarction VSD diagnosed 11 months post-MI resolved heart failure symptoms at 2-week follow-up.
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