Long-term surviving intramyocardial dissection following ventricular septal perforation secondary to inferior myocardial infarction with non-surgical treatment

A 71-year-old woman was diagnosed with a subacute myocardial infarction caused by an obstruction in the middle segment of the right coronary artery. Two hours after successful percutaneous coronary intervention, bedside transthoracic echocardiography revealed an interventricular septal perforation. Three hours later, the patient developed cardiac tamponade. An emergency pericardiocentesis was performed, which promptly restored hemodynamic stability. Echocardiographic findings suggested oozing from a minor perforation of the postinfarct inferior wall. Subsequent cardiac magnetic resonance imaging identified a basal inferoposterior septal perforation connected with an intramyocardial dissection. After intensive medical management, the patient gradually recovered and was discharged on the 135th day of admission. Five years of follow-up were uneventful with optimal medication therapy.

Learning objective

- Ventricular septal perforation following a myocardial infarction can result in intramyocardial dissection, which may extend to the epicardium and eventually lead to cardiac tamponade.

- Physicians should individualize treatment strategies for each patient based on various factors, especially in cases with rare and complex post-infarct complications.

- Advanced imaging techniques are recommended for assessing complex mechanical complications following a myocardial infarction.