Subacute Ventricular Septal Rupture Following Elective Percutaneous Coronary Intervention for Chronic Coronary Syndrome

Background:Ventricular septal rupture (VSR) is a well-documented mechanical complication of acute coronary syndrome (ACS); however, its occurrence following elective percutaneous coronary intervention (PCI) for chronic coronary syndrome is extremely rare, with only isolated cases reported in the literature.This report describes the case of an unexpected subacute VSR after an otherwise uneventful elective revascularization. Case Report:A 71-year-old woman with chronic coronary syndrome, diabetes, and hypertension underwent successful elective PCI to the left anterior descending artery.Despite an uncomplicated immediate procedural result, she experienced chest pain and ventricular fibrillation 6 hours post-procedure, requiring brief cardiopulmonary resuscitation and immediate defibrillation.Urgent control angiography demonstrated complete stent patency without dissection, thrombosis, or embolization.However, at 34 hours post-PCI, the patient developed sudden-onset dyspnea and rapid hemodynamic collapse.Physical examination revealed a new, harsh pansystolic murmur at the mesocardiac border.Emergency bedside transthoracic echocardiography confirmed an apical VSR with a significant left-to-right shunt.Due to ongoing severe hemodynamic collapse and an extremely high surgical risk, percutaneous transcatheter closure was attempted as a bail-out procedure; however, the patient died during the intervention in the catheterization laboratory.No postmortem tissue exam or direct procedural anatomical inspection of the VSR site was feasible. Conclusions:This case indicates that life-threatening mechanical complications like VSR can potentially occur outside the traditional paradigm of ACS, extending into the setting of elective revascularization for severe, chronic lesions.Rather than establishing a broad clinical standard, this report highlights the critical importance of post-procedural vigilance and a low threshold for prompt bedside echocardiographic evaluation whenever unexpected hemodynamic instability or a new murmur arises following PCI.