Case Report
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World J Cardiol. May 26, 2013; 5(5): 151-153
Published online May 26, 2013. doi: 10.4330/wjc.v5.i5.151
Impact of cardiac magnet resonance imaging on management of ventricular septal rupture after acute myocardial infarction
Tobias Gassenmaier, Armin Gorski, Ivan Aleksic, Nikolas Deubner, Frank Weidemann, Meinrad Beer
Tobias Gassenmaier, Meinrad Beer, Department of Radiology, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
Armin Gorski, Ivan Aleksic, Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
Nikolas Deubner, Frank Weidemann, Department of Internal Medicine I, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
Meinrad Beer, Department of Pediatric Radiology, Institute of Radiology, Medical University of Graz, 8036 Graz, Austria
Author contributions: Gassenmaier T wrote the paper and researched the literature; Gorski A performed surgical repair, and wrote the part of the paper concerning the surgical procedure; Aleksic I, Deubner N and Weidemann F contributed to treatment of the patient and critical review of the paper; Beer M contributed to imaging and critical review of the paper.
Supported by The German Research Foundation (DFG) and the University of Wuerzburg through the Open Access Publishing Funding Programme
Correspondence to: Tobias Gassenmaier, MD, Department of Radiology, University Hospital Wuerzburg, 97080 Wuerzburg, Germany. gassenmaier@roentgen.uni-wuerzburg.de
Telephone: +49-931-20134200 Fax: +49-931-20134209
Received: February 20, 2013
Revised: April 3, 2013
Accepted: April 28, 2013
Published online: May 26, 2013
Processing time: 94 Days and 7.3 Hours
Abstract

A 74-year-old man was admitted to the cardiac catheterization laboratory with acute myocardial infarction. After successful angioplasty and stent implantation into the right coronary artery, he developed cardiogenic shock the following day. Echocardiography showed ventricular septal rupture. Cardiac magnet resonance imaging (MRI) was performed on the critically ill patient and provided detailed information on size and localization of the ruptured septum by the use of fast MRI sequences. Moreover, the MRI revealed that the ventricular septal rupture was within the myocardial infarction area, which was substantially larger than the rupture. As the patient’s condition worsened, he was intubated and had intra-aortic balloon pump implanted, and extracorporeal membrane oxygenation was initiated. During the following days, the patient’s situation improved, and surgical correction of the ventricular septal defect could successfully be performed. To the best of our knowledge, this case report is the first description of postinfarction ventricular septal rupture by the use of cardiac MRI in an intensive care patient with cardiogenic shock and subsequent successful surgical repair.

Keywords: Cardiac magnetic resonance imaging, Ventricular septal rupture, Myocardial infarction, surgical repair, Extracorporeal membrane oxygenation

Core tip: We report on the case of a 74-year-old man who developed cardiogenic shock and ventricular septal rupture following an episode of acute myocardial infarction. Cardiac magnet resonance imaging (MRI) provided detailed information on size, localization and tissue integrity of the ruptured septum with respect to the myocardial infarction zone, followed by successful surgical repair of the defect. To the best of our knowledge, this case report is the first description of post-infarction ventricular septal rupture by the use of cardiac MRI in an intensive care patient with cardiogenic shock and subsequent successful surgical repair.