Introduction
Ventricular septal rupture (VSR) is a rare complication of myocardial
infarction that classically presents within one week of
infarction1 as coagulation necrosis occurs within the
infarcted tissue. Prior to the widespread use of reperfusion therapy,
VSR was estimated to complicate between 1-3% of acute myocardial
infarctions,2-4 whereas more recent estimates quote an
incidence of 0.17%-0.34%.5,6 While uncommon, VSR
carries a high risk of mortality when it occurs, estimated between
19-54% even with optimal treatment.2, 7-10
Although some controversy exists regarding the optimal timing of repair,
surgical treatment remains the mainstay of therapy. Without surgical
consultation and repair, blood flow is shunted from the high-pressure
left ventricle (LV) into the low-pressure right ventricle (RV),
resulting in RV overload, pulmonary congestion, and eventual
biventricular failure. Herein we present a rare case in which VSR
occurred during a cardiopulmonary bypass (CPB) run for urgent coronary
artery bypass grafting (CABG).