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

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.