Post-infarction ventricular septal rupture at non-surgical centers without mechanical circulatory support: A case series

Background: There is an extremely high death rate linked with post-infarction ventricular septal rupture (VSR), a mechanical consequence of acute myocardial infarction. Early identification and prompt medical stabilisation are essential for VSR in non-surgical institutions without mechanical circulatory support (MCS). This is to ensure a safe transfer between hospitals for final surgery. Case Illustrations: Two individuals with acute VSR after late-presentation anteroseptal ST-elevation myocardial infarction (STEMI) are described in this case series. A male patient, 85 years old, was taken to the hospital in a state of decompensated cardiogenic shock with multiorgan failure after he presented with symptoms 9 days after they began. He was unfit for transfer because his hemodynamic condition remained extremely unstable despite vigorous dual-inotropic support, pharmaceutical optimisation, and constant diuresis. He passed away on the fifth day after a quick decline. In contrast, the baseline hemodynamics and relatively preserved left ventricular function were observed in Patient 2, a 65-year-old male who presented three days after the start of symptoms. His medications for temporary heart failure and new-onset atrial fibrillation were antiplatelets, antiarrhythmics, and pharmacological afterload reduction, all of which helped to stabilise him. Day six saw his secure transport to a tertiary centre for final surgical closure. Conclusions: In non-surgical facilities without MCS, transfer viability depends on preserving end-organ perfusion before irreversible multiorgan failure occurs. Early pharmacological afterload reduction lowers SVR and left-to-right shunting, maintaining hemodynamic stability for transfer, whereas aggressive vasopressor escalation increases afterload, exacerbates shunting, and accelerates clinical collapse.