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Ventricular Septal Rupture Causing Acute Severe Tricuspid Valve Regurgitation in the Setting of a Neglected Myocardial Infarction: a Case Report

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Abstract

Ventricular septal rupture (VSR) is an uncommon but fatal mechanical complication of myocardial infarction (MI). It should be diagnosed as early as possible because it carries a very high mortality rate. Surgical closure remains the main line of treatment. A 75-year-old female patient presented with neglected extensive anterior STEMI. Clinical examination revealed pansystolic murmur over the left lower sternal border. 2D echo showed VSR and severe TR with normal right side dimensions and function. 3D Echo revealed that the cause of acute TR was the VSR left to right shut. Coronary angiography showed total LAD occlusion. The patient developed cardiogenic shock shortly after admission and died before surgery. This case demonstrated a rare mechanical complication of VSR. It signified the importance of cardiac auscultation, the strength of 3D echo in diagnosing structural heart disease. It also highlighted the disastrous impact of acute ischemic mechanical complications.

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Abbreviations

VSR:

Ventricular septal rupture

TR:

Tricuspid regurgitation

CAD:

Coronary artery disease

MI:

Myocardial infarction

STEMI:

ST segment elevation myocardial infarction

2D:

Two-dimensional

3D:

Three-dimensional

LAD:

Left anterior descending artery

LCx:

Left circumflex artery

RCA:

Right coronary artery

ECG:

Electrocardiogram

NSR:

Normal sinus rhythm

LIMA:

Left internal mammary artery

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Authors and Affiliations

  1. Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Moustafa Dawood, Hoda Shehata, Rasha Abayazeed, Ahmed El Amrawy & Mohamed Ayman Abdel-Hay

Authors
  1. Moustafa Dawood
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  2. Hoda Shehata
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  3. Rasha Abayazeed
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  4. Ahmed El Amrawy
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  5. Mohamed Ayman Abdel-Hay
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Contributions

Moustafa Dawood performed the 2D echo at presentation and discovered the VSR. Hoda Shehata and Rasha Aba-yazeed performed the 3D echo and linked the VSR to the acute severe TR. Ahmed El Amrawy performed the coronary angiography. Mohamed Abdel-Hay was the head of our echo lab and revised the case. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Moustafa Dawood.

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The authors declare no competing interests.

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Dawood, M., Shehata, H., Abayazeed, R. et al. Ventricular Septal Rupture Causing Acute Severe Tricuspid Valve Regurgitation in the Setting of a Neglected Myocardial Infarction: a Case Report. SN Compr. Clin. Med. 4, 76 (2022). https://doi.org/10.1007/s42399-022-01157-6

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  • DOI: https://doi.org/10.1007/s42399-022-01157-6

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