Introduction. Ventricular septal rupture (VSR) in the acute myocardial
infarction (AMI) is a rare but very serious complication, still associated
with high mortality, despite significant improvements in pharmacological and
surgical treatment. Therefore, hybrid approaches are introduced as new
therapeutical options. Case Outline. We present an urgent hybrid approach,
consisting of the initial percutaneous coronary intervention (PCI) of the
infarct-related artery, followed by immediate surgical closure of the
ventricular septal rupture, for treatment of high risk, hemodynamically
unstable female patient with AMI caused by one-vessel disease and complicated
by VSR and cardiogenic shock. Since the operative risk was also very high
(EUROSCORE II 37%), this therapeutic decision was based on the assumption
that preoperative PCI could promptly establish blood flow and thereby lessen
the risks, duration and complexity of urgent cardiosurgical intervention,
performed on the same day. This approach proved to be successful and the
patient was discharged from the hospital on the fifteenth postoperative day
in stable condition. Conclusion. In selected cases, with high operative risk
and unstable hemodynamic state due to AMI complicated by VSR, urgent hybrid
approach consisting of the initial PCI followed by surgical closure of VSR
may represent an acceptable treatment option and contribute to the treatment
of this complex group of patients.
Surgical Closure of Ischemic Ventricular Septal Rupture: a case report
