Small septal vessel occlusion results in big damage: ventricular septal dissection and rupture

Small septal vessel occlusion results in big damage: ventricular septal dissection and rupture A 65-year-old man presented with a 3-day history of dyspnoea and palpitations. On admission, he was hypotensive (92/60 mmHg) and had tachycardia (113 b.p.m.). The electrocardiogram showed mild ST-segment elevation in leads V1–V4. Blood analysis revealed mildly elevated troponin T. Transthoracic echocardiogram revealed ventricular septal dissection and rupture, with a maximum diameter of the left and right ventricular orifice of 2.1 cm and 0.8 cm, respectively (Panels A–C). Colour Doppler flow imaging showed a bidirectional shunt between the left and right ventricles (Panels D and E). The left ventricle showed no wall motion abnormality except for the dissected septum with an ejection fraction of about 70%. The coronary angiogram showed a total occlusion of the first septal branch (Panel F), which was treated successfully by balloon angioplasty (Panel G), as well as showing an intermediate lesions on the mid and distal left anterior descending artery. After admission, the patients’ condition worsened and the dissection expanded, septal rupture enlarged on repeat echocardiogram (Panels H and I, Supplementary material online, Videos S1–S3). He was stabilized and recompensated with the use of intravenous medicine and an intra-aortic balloon pump. He underwent percutaneous closure of the defect 2 months after admission with an 1618-mm HeartR™ patent ductus arteriosus occluder (LifeTech Scientific Corporation, Shenzhen, China), with small residual shunt (Panels J–L) and no sign of dissection on transthoracic echocardiogram. At 6 months of follow-up, the case remained symptom free. Ventricular septal dissection and rupture are the rare complications of acute myocardial infarction, almost always associated with major coronary artery lesions. To our knowledge, this is the first report of ventricular septal dissection and rupture caused by septal branch occlusion, which was corrected by using a percutaneous approach. Supplementary material is available at European Heart Journal online. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Small septal vessel occlusion results in big damage: ventricular septal dissection and rupture

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Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology.
ISSN
0195-668X
eISSN
1522-9645
D.O.I.
10.1093/eurheartj/ehy240
Publisher site
See Article on Publisher Site

Abstract

A 65-year-old man presented with a 3-day history of dyspnoea and palpitations. On admission, he was hypotensive (92/60 mmHg) and had tachycardia (113 b.p.m.). The electrocardiogram showed mild ST-segment elevation in leads V1–V4. Blood analysis revealed mildly elevated troponin T. Transthoracic echocardiogram revealed ventricular septal dissection and rupture, with a maximum diameter of the left and right ventricular orifice of 2.1 cm and 0.8 cm, respectively (Panels A–C). Colour Doppler flow imaging showed a bidirectional shunt between the left and right ventricles (Panels D and E). The left ventricle showed no wall motion abnormality except for the dissected septum with an ejection fraction of about 70%. The coronary angiogram showed a total occlusion of the first septal branch (Panel F), which was treated successfully by balloon angioplasty (Panel G), as well as showing an intermediate lesions on the mid and distal left anterior descending artery. After admission, the patients’ condition worsened and the dissection expanded, septal rupture enlarged on repeat echocardiogram (Panels H and I, Supplementary material online, Videos S1–S3). He was stabilized and recompensated with the use of intravenous medicine and an intra-aortic balloon pump. He underwent percutaneous closure of the defect 2 months after admission with an 1618-mm HeartR™ patent ductus arteriosus occluder (LifeTech Scientific Corporation, Shenzhen, China), with small residual shunt (Panels J–L) and no sign of dissection on transthoracic echocardiogram. At 6 months of follow-up, the case remained symptom free. Ventricular septal dissection and rupture are the rare complications of acute myocardial infarction, almost always associated with major coronary artery lesions. To our knowledge, this is the first report of ventricular septal dissection and rupture caused by septal branch occlusion, which was corrected by using a percutaneous approach. Supplementary material is available at European Heart Journal online. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Journal

European Heart JournalOxford University Press

Published: Apr 30, 2018

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