Introduction: The major mechanical complications after acute ST elevation myocardial infarction (STEMI) include rupture of the left ventricular free wall, papillary muscle rupture and ventricular septal rupture. Preoperative optimization, with an intra-aortic balloon pump and vasodilators, inotrops may help to reduce the afterload on the compromised ventricle following AMI and may improve cardiac output in the short term, but should not delay expedient surgical intervention.
Methods: We presented the case of a women with late presentation after anterior STEMI complicated with interventricular septal defect trated at Cardiovasculare Disease Institute Timisoara.
Case presentation: A 60 years old women was diagno-se with anterior STEMI after 72 hours of beginning chest pain. Now she presented in our hospital with shortness of breath, fatigue and recurrence of chest pain. His blood pressure was 70/40 mmHg, and he had signs of systemic hypoperfusion. Cardiac auscultation revealed a harsh holosystolic murmur, which was heard over the entire precordium. Transthoracic echocardio-graphy revealed a left ventricle with anterior akinesis and a sharply demarcated interventricular septal defect (VSD) with a large, turbulent left-to-right transseptal flow. Coronary angiography revealed occlusion of the LAD with poor retrograd collateral flow from right coronary artery. Emergency surgical intervention was performed because of persistent cardiogenic shock, despite supportive therapies, including intraaortic bal-loon pump. A surgical repair of postinfarction VSD was performed using Tiron David infarct exclusion technique and concomitant coronary artery by-pass grafting (left internal mammary artery on LAD). After eleven days’ patients was discharged.
Conclusions: Surgical intervention remains the main-stay of treatment in patients with mechanical complications of STEMI, with dismal outcomes for patients trea-ted medically. In conclusion, „best medical treatment” for mechanical complication of STEMI is surgery.