Impact of cardiac magnetic resonance imaging in the management of post myocardial infarction ventricular septal rupture- a case report
Abstract
A 61-year old man, a known
diabetic and hypertensive, presented to
us with worsening dyspnea of 25 days
duration with pan-systolic murmur at left
parasternal region without thrill. One
month ago, he suffered from ST-segment
elevation anterior wall myocardial infarction
with window period of 24 hours. He
was taken up for coronary angiography
and subsequently, balloon angioplasty
with thrombosuction of the left anterior
descending coronary artery was done.
He developed sudden onset of dyspnea
on the 5th day of admission which progressed
to NYHA class III dyspnea when
he presented to us. Echocardiogram
showed 8 mm ventricular septal defect
near apex with left to right shunt with
moderate tricuspid regurgitation and pulmonary
artery hypertension. Cardiac
magnet resonance imaging was performed,
which provided detailed information
on size and localization of the ruptured
septum as well as viability of myocardium.
It showed thinning of the myocardium
and ballooning in the left ventricular
apical region with moderate
left ventricular systolic dysfunction. There
was defect in the interventricular septum at
the apical region of 18 10 mm. Moreover,
MRI revealed that the ventricular septal
rupture was within the myocardial infarction
area, which was substantially larger than
the rupture. Severe hypokinesia and
greater than 75 late gadolinium enhancement
was present in the LAD territory (middistal
septum and apical regions) suggestive
of non-viable myocardium. Subsequently,
patient underwent successful surgical
closure of the defect (a Gore-Tex
patch closure) along with saphenous venous
grafting to LAD. He was completely
asymptomatic and in NYHA class I at 1
month of follow-up. Our case emphasizes
the impact of cardiac magnetic resonance
imaging in the management of such rare
complication of acute myocardial infarction
and its advantages over other imaging modalities.
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