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Post-infarction ventricular septal defect: triggered by
Valsalva manoeuvre?
M BASKURT, N TURHAN, A HATEMİ, M CANİKOGLU, B KARADAG, S KUCUKOGLU
Summary
Post-infarction ventricular septal defect (VSD) is a fatal
mechanical complication of myocardial infarction. Although
the incidence has decreased to less than 1% after the exten-
sive use of reperfusion strategies, post-infarction VSD still
carries a high mortality risk. Management is controversial,
whether to wait for surgery after a stabilisation period or to
perform emergency surgery when diagnosed. We report on
a case of post-infarction VSD that was detected with severe
haemodynamic instability, beginning immediately after the
patient’s Valsalva manoeuvre on the sixth day of a non-reper-
fused inferior myocardial infarction. In the early period, the
post-infarction VSD was repaired via a trans-aneurysmal
approach.
Keywords:
ventricular septal defect, post myocardial infarction
complications
Submitted 18/8/09, accepted 10/3/10
Cardiovasc J Afr
2010;
21
: 329–332
CVJ-21.009
The incidence of post-infarction ventricular septal defect (VSD)
was 1–3% in the pre-thrombolytic era, but it has declined to near-
ly 0.2% in the era of thrombolysis.
1
The average time interval for
a post-infarction VSD to occur is at five to six days if thrombo-
lytic therapy is not used, and one day with thrombolytic adminis-
tration.
2
In-hospital mortality is still more than 90% with medical
therapy and between 19 and 60% with a surgical approach.
3
VSD complicating an inferior myocardial infarction (MI) has
a poorer prognosis than a VSD complicating an anterior MI.
4
We report on a case of post-infarction VSD in a patient who
did not receive thrombolytic therapy because of late presentation.
On the sixth day of the inferior MI, after a period of Valsalva
manoeuvre, she developed sudden haemodynamic deterioration
and symptoms and signs of acute heart failure. After the diagno-
sis of post-infarction VSD, we performed emergency surgery and
repaired the defect by teflon strip with pladgeted prolene sutures
via a trans-aneurysmal approach.
Case report
A 62-year-old female patient was admitted to our hospital with
typical enduring chest pain that had started two days earlier. Her
Department of Cardiology, Institute of Cardiology, Istanbul
University, Haseki, Istanbul
MURAT BASKURT, MD,
NİHAN TURHAN, MD
SERDAR KUCUKOGLU, MD
Department of Cardiovascular Surgery, Institute of
Cardiology, Istanbul University, Haseki, Istanbul
ALİCAN HATEMİ, MD
MUSTAFA CANİKOGLU, MD
Department of Cardiology, Cerrahpasa School of Medicine,
Istanbul University, Cerrahpasa, Istanbul
BİLGEHAN KARADAG, MD
Case Report
