Abstract 4367551: Delayed Post-Infarction Ventricular Septal Defect: A Case Report Highlighting Diagnostic Challenges and Choice of Surgical Management

Background: Post-Myocardial Infarction Ventricular Septal Defect (PIVSD) is a rare and life-threatening mechanical complication following acute myocardial infarction (MI). It presents with symptoms ranging from sudden dyspnea, chest pain, and hemodynamic instability to cardiogenic shock. This case report highlights the importance of early identification and management of PIVSD. Case Summary: This case report presents the case of a 70-year-old female who presented to a community hospital in Pakistan in January 2024 with chest pain and progressive dyspnea that started seven days after an MI diagnosis. Her echocardiogram revealed an apical VSD, while coronary angiography confirmed dual-vessel coronary artery disease. Subsequently, she underwent elective subacute surgical repair of a 3x3 cm apical VSD along with coronary artery bypass grafting (CABG) and intra-aortic balloon pump placement. Postoperatively, she developed a ventricular thrombus, which was managed with anticoagulation. Follow-up echocardiography demonstrated marked clinical improvement. Conclusion: This case highlights the diagnostic challenges of PIVSD and emphasizes the importance of considering early surgical intervention for improved outcomes, while acknowledging the role of delayed repair in achieving better scar tissue management and a higher successful surgery rate. Moreover, sudden hemodynamic compromise following MI warrants suspicion of PIVSD.