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Ventricular aneurysm and ventricular septal defect after myocardial infarction
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  • Published on: 22 February 2022
    The delayed presentation of mechanical complications of myocardial infarction
    • oscar,m jolobe, retired geriatrician British Medical Association. Also a member of the Manchester Medical Society(but not an affiliate)

    The delayed presentation of the association of left ventricular aneurysm(LVA) and ventricular septal rupture(VSR), reported by Patel et al(1), has its counterpart in the even longer delay, amounting to 3 months, documented in a 53 year old man who presented with increasing breathlessness and no history of chest pain. His delay in seeking medical attention was put down to to "apprehension sorrounding COVID-19". His electrocardiogram(ECG) showed ST segment elevation in the inferior leads. Coronary angiography showed severe multi-vessel disease including complete occlusion of the mid-right coronary artery. Transthoracic echocardiography(TTE) showed a basal inferior wall aneurysm and small ventricular septal rupture(VSR) with left- to -right shunt. Cardiac magnetic resonance imaging showed that the LVA measured 52 mm x 53 mm x 44 mm, with an associated mural thrombus. VSR and right-to-left shunt was confirmed. The patient experienced a successful, outcome from 3-vessel coronary artery bypass grafting, aneurysmectomy, and VSR patch repair(2).
    Takotsubo cardiomyopathy(TTC) is another context for LVA(3) and for VSR(4), respectively. Furthermore, the association of ventricular free wall rupture(presumably a complication of ventricular pseudo aneurysm) and VSR can also be a feature of TTC(5). In the latter report a 73 year old woman presented with a 5 days history of chest pain and breathlessness. Her ECG showed ST elevation in leads V2-V5. TTE showed...

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    Conflict of Interest:
    None declared.