A case report of a triple patch reconstruction of a post-infarction ventricular septal rupture: microaxial flow pump support as a bridge to surgery

Ventricular septal rupture is a rare but devastating complication of acute myocardial infarction, frequently associated with cardiogenic shock and poor prognosis. Data regarding successful treatment strategies remain limited, and operative mortality significantly decreases when surgery can be delayed by 7–14 days.

We present the case of a 61-year-old patient diagnosed with a posterior transmural myocardial infarction complicated by a large ventricular septal rupture. Right heart catheterization showed significant right ventricular (RV) overload, with elevated right atrial pressure (20 mmHg), right ventricular end-diastolic pressure (22 mmHg), and an elevated mean pulmonary artery pressure (44 mmHg). Due to the cardiogenic shock, we reduced the left-to-right shunt and achieved right ventricular unloading using a percutaneous microaxial flow pump (mAFP) with 5.5 L/min support as a bridge to surgical repair. This hemodynamic stabilization enabled a novel approach using triple patch reconstruction for post-infarction ventricular septal rupture.

This case highlights the effectiveness of early hemodynamic support with percutaneous mAFP in stabilizing patients with acute ventricular septal rupture, facilitating delayed surgical intervention, allowing time for infarct tissue to scar. The combined use of advanced surgical techniques and mechanical support may represent a key strategy in the management of this complex condition.