Multifenestrated ventricular septal rupture in a patient with ST-segment elevation myocardial infarction

Mechanical complications following ST-segment elevation myocardial infarction (STEMI) are now relatively rare due to the implementation of early percutaneous revascularization therapies.Ventricular septal rupture (VSR) occurs in 0.17-0.21% of cases and is corrected via either endovascular or open approaches.We present the case of a 70-year-old male patient with STEMI who, following coronary angioplasty, was diagnosed with a multifenestrated ventricular septal defect, subsequently repaired using an autologous pericardial patch.The patient presented with oppressive precordial chest pain and was diagnosed with STEMI.Angioplasty with a drug-eluting stent was performed on the left anterior descending artery.A follow-up echocardiogram revealed a ventricular septal defect with three openings located in the anteromedial portion of the interventricular septum.The defect was surgically closed through an open approach using an autologous pericardial patch, with no evidence of residual shunting on follow-up echocardiography.Mortality associated with STEMI increases significantly when mechanical complications, such as VSR, are present, with reported mortality rates of 73.6%.Initial evaluation of the defect should prioritize endovascular closure, as it has been associated with lower mortality compared to open repair.However, when the defect lacks well-defined borders or is large or multifocal, open repair is preferred.Open repair techniques can be categorized into two main approaches: direct defect closure with continuous sutures or closure with a patch.