Ischemic ventricular septal rupture with patent coronary bypass grafts due to occluded septal branch, a case report

Authors

  • Mohammad El Diasty Division of Cardiac Surgery. Queen’s University, Kingston, ON, Canada https://orcid.org/0000-0002-1807-8397
  • Rubab Fatima School of Medicine. Queen’s University, Kingston, ON, Canada
  • Angel L. Fernandez Department of Cardiac Surgery. University Hospital, Santiago de Compostela, Spain
  • Igo Ribeiro Division of Cardiac Surgery. Queen’s University, Kingston, ON, Canada

DOI:

https://doi.org/10.48729/pjctvs.243

Abstract

Background: Ischemic ventricular septal rupture (VSR) is a lethal complication that occurs either after spontaneous or iatrogenic occlusion of one of the major epicardial coronary vessels. To the best of our knowledge, this is the first reported case of a VSD after a septal branch occlusion in a patient with patent coronary artery grafts to both the left anterior descending and posterior descending arteries.

Methods: We present a rare case of anterior ischemic VSR due to the occlusion of a major septal branch. The patient had previous coronary artery bypass grafts and his left internal mammary artery conduit to the anterior descending artery was patent. The culprit lesion that resulted in the development of the VSR was the occlusion of a major septal branch.

Discussion: The presence of collateral circulation in chronic coronary occlusive disease may provide a protective effect against the development of transmural myocardial necrosis which may reduce the risk of septal rupture. This case highlights the fact that patent coronary artery grafts may not protect from future ischemic VSR.

Conclusion: Major septal branches with significant disease should be assessed for percutaneous options if technically feasible as dictated by the Heart Team.

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References

Figueras J, Alcalde O, Barrabes JA, et al. changes in hospital mortality rates in 425 patients with acute ST-elevation myocardial infarction and cardiac rupture over a 30-year period. Circulation. 2008: 118: 2783-2789.

Zhong X, Zhou G, Huan Z, Wang X, Wang L, Yang J. Small septal vessel occlusion results in big damage: ventricular septal dissection and rupture. Eur Heart J 2018; 39: 2506-2507.

Kaneko S, Isoda S, Matsuki Y, Yamazaki I, Masuda M. Post-infarction ventricular septal defect due to an isolated septal myocardial infarct. J Card Surg. 2017; 32:487-488.

Fujii N, Tsuchihashi K, Nishida J, Funayama N, Takagi S, Miura T. Delayed ventricular septal perforation caused by minimal branches occlusion during coronary artery stenting Cardio- vasc Interv Ther. 2013; 28:383-387.

Yoshizaki T, Ishida M, Takagi T, et al. A case of ventricular septal rupture associated with major septal branch occlusion after percutaneous coronary intervention. J Cardiol Cases. 2014; 10: 140-143.

Skehan JD, Carey C, Norrell MS, Belder M, Balcon R, Mill PG. Patterns of coronary artery disease in post-infarction ventricular septal rupture. Br Heart J. 1989; 62: 268-272.

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Published

03-07-2022

How to Cite

1.
El Diasty M, Fatima R, Fernandez AL, Ribeiro I. Ischemic ventricular septal rupture with patent coronary bypass grafts due to occluded septal branch, a case report. Rev Port Cir Cardiotorac Vasc [Internet]. 2022 Jul. 3 [cited 2022 Sep. 27];29(2):57-8. Available from: https://pjctvs.com/index.php/journal/article/view/243

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Clinical Cases

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