Extremely Late Post-Infarction Ventricular Septal Rupture: A Case Report of Successful Surgical Repair

Davila-Flores D.; Gutiérrez-Yllu A.; Baltodano-García B.; Junes-Gonzales W.; Montesinos-Segura R. · Archivos Peruanos de Cardiologia y Cirugia Cardiovascular (2026) · DOI: 10.47487/apcyccv.v7i2.602

Resumen

Mechanical complications of ST-elevation myocardial infarction have become rare in high-income settings due to timely reperfusion. However, they remain more prevalent and carry a high mortality in regions lacking access to early reperfusion. We present a 62-year-old man with inferior STEMI managed conservatively without reperfusion. At four months, he developed progressive dyspnea. One year later, echocardiography revealed a large basal ventricular septal rupture and severe eccentric mitral regurgitation, all absent at discharge. The patient’s transfer to a cardiovascular surgery center was delayed by two years, a consequence of the COVID-19 pandemic. Imaging confirmed an inferobasal left ventricular pseudoaneurysm, basal ventricular septal rupture, severe mitral regurgitation, and a left ventricular ejection fraction of 45%. Right heart catheterization showed a significant left-to-right shunt; coronary angiography revealed multivessel coronary artery disease. He underwent successful surgical repair and remained asymptomatic at the three-year follow-up.

Instituciones: Universidad Peruana de Ciencias Aplicadas; Universidad de San Martín de Porres