Long-term survival without surgical intervention in a patient with acute myocardial infarction and ventricular septal perforation: case report

Background: Ventricular septal rupture (VSR) is a rare and catastrophic complication of acute myocardial infarction (AMI). In the absence of timely diagnosis and surgical intervention, the short-term mortality rate for such patients exceeds 90%. Due to its grave prognosis, the current therapeutic strategy for VSR primarily focuses on urgent surgical repair. Therefore, there are few documented cases of VSR where patients have survived for long time without surgical treatment. Case presentation: An outpatient transthoracic echocardiogram conducted on a 51-year-old male patient unveiled a 12-mm echogenic defect located at the apex of the ventricular septum, which exhibited a left-to-right shunt during systole, findings that are consistent with the diagnosis of VSR. Four years prior, the patient had suffered from chest pain and tightness, accompanied by transient loss of consciousness. Subsequent comprehensive diagnostic evaluations, including coronary angiography, technetium-99m sestamibi single photon emission computed tomography, and cardiac magnetic resonance, revealed that the patient had remarkably survived a prolonged period without surgical intervention following a rare and complex post-myocardial infarction complication: VSR. Conclusions: This patient is a rare case report in which VSR and unobstructed coronary arteries survived for a long time without surgical intervention. The most probable explanation for the observed haemodynamic stability is that the aberrant myocardial bundle dynamically partitions the right ventricular cavity into proximal high-pressure and distal low-pressure zones. This results in the preservation of the integrity of the systemic circulation via a distinctive intracardiac pressure gradient.