Clinical Outcomes of Ventricular Septal Rupture Complicating ST-Segment Elevation Myocardial Infarction: A Case Series from Siriraj Hospital and Literature Review

Objective: To access the clinical outcomes of ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) patients in the Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.

Materials and Methods: The authors retrospectively reviewed the medical records of Siriraj Hospital between January 2005 and December 2021 in line with the International Classification of Disease, version 10 (ICD-10) code I23.2, which revealed 18 patients who matched the search. Among these, three patients were excluded from the present study as one patient could not access the admission data and the other two were not truly VSR.

Results: In total, 15 VSR patients were included in the analysis, comprising eight males and seven females, with mean age of 67.53±7.95 years old. Of all the patients, 60% had anterior ST-segment elevation myocardial infarction. The mean left ventricular ejection fraction was 53.13±14.98%. Coronary angiography was performed in 14 patients (93.37%). In 50% of the patients, left anterior descending artery was the culprit lesion. Ten patients had multi-vessel diseases. Six patients underwent percutaneous coronary intervention (PCI), with the rate of successful reperfusion at 83.33%. For the six patients who underwent PCI, the procedure was performed before the VSR surgical repair. Ten patients underwent coronary artery bypass graft. For the 12 patients who underwent VSR surgical repair, the in-hospital survival rate was 100%. The overall in-hospital mortality rate was 20%. The non-survival patients did not receive the VSR surgical repair. After the median follow-up of three years, no additional mortality rate was reported.

Conclusion: The mortality rate of VSR complicating AMI is high, especially, for patients who are not feasible for VSR repair. However, given the limitation in the number of patients involved in the present analysis, the authors could not identify the risk factors for developing in-hospital adverse outcomes.

Keywords: Ventricular septal rupture; Acute myocardial infarction; Mechanical complications of myocardial infarction