Ventricular Septal Rupture – A Rare and lethal complication of a heart attack

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61 year old Mrs. Sisirkana Bera from Midnapore,was brought to the emergency of Peerless Hospital with severe chest pain. She was indeed having a heart attack.Despite receiving timely treatment,she collapsed after 48hrs. On investigation she was found to have a Ventricular Septal Rupture (VSR). VSR is a rare but lethal complications of aheart attack. It essentially means the tearing or rupture of dead heart tissue. She was then immediately taken to the OT for the repair of the same.

“This entire procedure, in general, is an uphill battle for the surgeon, where we battle distorted anatomy, extremely friable tissue which refuses to hold sutures and  bleeding issues requiring multiple transfusions. Mrs.Bera and her family had full trust in Peerless Hospital and even after battling all odds the cardiac team are left with the daunting task of weaning the patient off Cardiopulmonary bypass. In this case we successfully overcame each of these obstacles.The rupture was repaired with a material called Dacron along with performing a bypass graft to the LAD- the offending coronary artery. The patient was then uneventfully discharged 8 dayslater, after confirming a successful repair (as seen in the post operative echocardiography). She continues to do well.” Said Dr.Priyadarshan Konar Consultant Cardiothoracic Surgeon who performed the surgery

Post-myocardial infarction(heart attack) ventricular septal rupture (VSR) is a dreaded complication that confers high morbidity and mortality in these patients.VSR is more likely to occur in patients who are older, female, hypertensive, have chronic kidney disease, and have no prior history of smoking. It commonly occurs in the setting of a first heart attack in the background of delayed or absent treatment. Post-myocardial infarction VSR occurs in 1% to 3% of patients with heart attack in the absence of reperfusion therapy. The incidence of VSR increases to 3.9% in patients with cardiogenic shock as a complication of a heart attack.

The treatment of choice is URGENT SURGICAL REPAIR.In medically treated patients with VSR, the mortality is 24% at 72 hours and increases to 75% at three weeks. Surgical mortality may range from 30% to 70% depending on the location of rupture.

The high mortality is attributed  to extremely friable tissue and the very complex nature of the repair.

Even though the management of a VSR is a nightmare for doctors, it’s successful repair and outcome is the most satisfying experience , achieved only by an extremely experienced and proactive Cardiac team of Peerless Hospital

DR. PRIYADARSHAN  KONAR

MBBS, MS (Gen Surgery), MCh (CTVS)

Consultant Cardio-Thoracic & Vascular Surgeon

Peerless Hospital

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