Ventricular Septal Rupture

Ventricular Septal Rupture (VSR) is a rare but serious complication, historically seen after myocardial infarction (MI). The incidence has decreased with reperfusion strategies, yet mortality remains high at 41-80%.

1. When should we worry about VSR?
Typically occurs after a first MI in patients with delayed or no reperfusion therapy, and in those with risk factors such as age, female sex, or history of heart failure and CKD.

2. Presentation of VSR
The classic sign is recurrent chest pain with hypotension, alongside a new harsh pansystolic murmur. Abrupt hemodynamic compromise should prompt suspicion.

3. Common Locations
The LAD supplies the apical septum, while the RCA supplies the basal inferoseptal wall. These are common VSR sites post-transmural infarct.

4. Classifications
Using the Becker and Mantgem system or simple vs. complex classification, VSR can be classified based on temporal relation to the infarct or the anatomical connection.

5. Management
Surgical repair is the definitive treatment. Timing is individualized, with a goal to reduce afterload medically in the interim.

Produced by: Dr. Eunice Dugan

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