Ventricular Septal Rupture After Acute Myocardial Infarction - Can Va-Ecmo Give Us Extra Time?

Abstract

Ventricular septal rupture (VSR) after myocardial infarction (MI) is a rare but life-threatening complication. Although surgery is the gold standard treatment, best surgical timing is still a matter of debate. Studies are showing a tendency towards survival improvement with delayed intervention on the assumption that scarring of the infarcted tissue may facilitate patch suturing and avoid relapse of the defect. Mechanical circulatory support (MCS) may be useful, not only for hemodynamic stabilisation and optimization before surgery, but also as a bridge to decide best surgical timing. Allowing myocardial recovery into a resistant scar, recurrence of VSR may be reduced and promotes a longer-lasting surgical repair. The aim of this case report is to share the outcomes and management of two MI-associated VSR patients submitted to delayed surgery after VA-ECMO stabilisation. Although VSR repair failed, VA-ECMO allowed the patient's stabilisation, time for decision and became a bridge for successful heart transplant.