Abstract
INTRODUCTION: Posterobasal ventricular septal rupture (P-VSR) developed after acute myocardial infarction (AMI) is often associated with right ventricular infarction and carries a high surgical mortality. The coexistence of tricuspid regurgitation (TR) further aggravates right ventricular dysfunction and right heart failure. Therefore, surgical repair of P-VSR complicated by right ventricular infarction and severe TR is particularly challenging. CASE PRESENTATION: A 75-year-old woman developed acute inferior myocardial infarction complicated by right ventricular infarction. A coronary stent was deployed for right coronary artery occlusion. On day 16 after the onset of AMI, transthoracic echocardiography revealed a P-VSR and severe TR, and she was transferred to our institution for surgical management. Through a right atrial approach, excellent visualization of the P-VSR was obtained. The septal defect was closed securely using two bovine pericardial patches placed on both the right and left ventricular sides of the ventricular septum. Tricuspid valve replacement (TVR) was also performed. Postoperative echocardiography confirmed complete closure of the defect without residual shunt. CONCLUSIONS: In the surgical treatment of P-VSR complicated by severe TR, a right atrial approach may provide adequate exposure of the septal defect while potentially minimizing additional ventricular injury. In selected patients with severe TR in a similar anatomical and clinical context, concomitant TVR may represent a feasible surgical option.