Postinfarction Ventricular Septal Rupture With Thin Membrane Preventing Cardiopulmonary Collapse

A 53-year-old man presented with dyspnea, orthopnea, and paroxysmal nocturnal dyspnea 1 week after an episode of severe chest pain. His electrocardiogram demonstrated inferior Q waves. He was hemodynamically stable, with clinical heart failure and a loud pansystolic murmur. Echocardiography showed a large ventricular septal defect on the basal inferior wall, with a thin septal membrane. This membrane had a small defect with left-to-right flow. Coronary angiography showed an occluded right coronary artery. A delayed patch repair and bypass graft were performed, with good success. No presurgical supports were required, as the membrane preserved hemodynamic integrity for 2 weeks.