Ventricular double rupture case of long-term survival without surgical repair

A 78-year-old asymptomatic male with a history of coronary artery disease was admitted for preoperative cardiovascular evaluation before noncardiac surgery. Auscultation revealed a Grade 3 holosystolic murmur at the left parasternal area. Transthoracic echocardiography documented ventricular double rupture (VDR), consisting of ventricular septal rupture, and rupture of the apical part of the left ventricular free wall with pseudoaneurysm formation. Hospital records revealed that VDR had been noticed 7 years ago during hospitalization due to anterior myocardial infarction. However, recommended surgical repair could not be performed because of the patient's refusal.