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18 September 2018 : Case report  Japan

Emergence of Ventricular Septal Rupture During Primary Coronary Intervention for Myocardial Infarction Manifested as Unexpected Coronary Blood Flow Disturbance

Unusual clinical course, Diagnostic / therapeutic accidents, Management of emergency care

Tetsuya Nomura1ABCDE*, Kenshi Ono1F, Yu Sakaue1F, Daisuke Ueno1F, Yusuke Hori1F, Kenichi Yoshioka1F, Masakazu Kikai1AEF, Natsuya Keira1AF, Tetsuya Tatsumi1G

DOI: 10.12659/AJCR.911084

Am J Case Rep 2018; 19:1108-1112

Abstract

BACKGROUND: As primary percutaneous coronary intervention (PCI) has been commonly performed for acute myocardial infarction (AMI), we rarely encounter ventricular septal rupture (VSR), which is one of the mechanical complications of AMI. However, the associated mortality rate is still very high unless treated appropriately.

CASE REPORT: We encountered a very rare case of VSR that was considered to have occurred during primary PCI for AMI. The manifestation of sudden coronary flow disturbance may correspond with the emergence of VSR. We introduced a veno-arterial extracorporeal membrane oxygenation (ECMO) system for sudden hemodynamic instability. As a result, the existence of VSR under the operation of the ECMO system led to unusual hemodynamics in the heart, but the vital signs were stabilized by ECMO. VSR was surgically treated and the patient fully recovered without any neurological or physical sequelae.

CONCLUSIONS: Although we now encounter markedly fewer mechanical complications of AMI in this era of primary PCI, we should always be conscious of its possibility in the acute phase of myocardial infarction.

Keywords: acute coronary syndrome, case reports, Ventricular Septal Rupture

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923