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. 2025 Jun 18;18(1):105.
doi: 10.1186/s12245-025-00907-2.

Ventricular double rupture following myocardial infarction: a case report and literature review

Camilo Andres Calderon-Miranda  1   2 , Carlos Enrique Vesga-Reyes  3   4 , Pastor Olaya  3   4 , Maria Juliana Reyes-Cardona  4   5 , Jairo Sanchez-Blanco  3   4 , Jorge Alexander Zambrano-Franco  3   4 , Gustavo Adolfo Cruz-Suarez  4   6 , Alvaro Diego Peña-Gonzalez  4   7
Affiliations

Ventricular double rupture following myocardial infarction: a case report and literature review

Camilo Andres Calderon-Miranda et al. Int J Emerg Med. .

Abstract

Background: The frequency of mechanical complications related to transmural myocardial infarction (MI) has decreased due to the widespread implementation of reperfusion therapies. However, mortality related to these complications remains high, requiring prompt intervention by a Heart Team. Ventricular double rupture (VDR) is a particularly rare and fatal MI complication.

Case presentation: A 58-year-old female patient presenting with 3 days of chest pain was diagnosed with ST-elevation MI. She underwent primary percutaneous coronary intervention of the left anterior descending artery. Transthoracic echocardiogram revealed an apical ventricular septum rupture and a mild pericardial effusion suggestive of free wall rupture. Emergent surgical repair included ventricular septal defect closure with a heterologous pericardial patch and repair of the free wall rupture with Dacron patch placement. Perioperative intraaortic balloon pump support was utilized. The patient had a favorable clinical course and was asymptomatic at her cardiology follow-up.

Conclusions: VDR is the combination of two types of mechanical complications of MI. High clinical suspicion is necessary in hemodynamically unstable patients and those with risk factors for myocardial rupture, warranting echocardiographic evaluation for its diagnosis and characterization. Treatment of VDR is primarily surgical and may involve mechanical circulatory support (MCS). Despite advances in reperfusion therapies and surgical techniques, the prognosis of VDR remains poor. Our patient had a favorable outcome highlighting the importance of a multidisciplinary approach.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12245-025-00907-2.

Keywords: Acute myocardial infarction; Echocardiography; Mechanical complications; Surgical treatment; Ventricular rupture.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This case report was reviewed and approved by the Institutional Review Board (IRB) of Fundación Valle del Lili, Cali, Colombia. The patient provided informed consent for the use and publication of their medical information, and all identifying details have been anonymized to ensure confidentiality. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Chest x-ray. Perihilar haze, upper lobe pulmonary venous diversion, septal lines, bilateral diffuse opacities, bilateral blunting of costophrenic angles, cardiomegaly. Centrally placed endotracheal tube, right subclavian central venous catheter with distal end projecting into the right atrium
Fig. 2
Fig. 2
Coronary angiogram. A Critical stenosis of the middle third of the left anterior descending artery. B 90% stenosis of the middle third of the posterior descending artery
Fig. 3
Fig. 3
Transthoracic echocardiogram. A Apical four-chamber view. Apical ventricular septal defect. Small pericardial effusion. Apical epicardial thrombus. B Color Doppler imaging: Left-to-right shunt through the VSD
Fig. 4
Fig. 4
Intraoperative photographic record. A The free wall rupture has been extended longitudinally to allow complete exposure of the interventricular defect. A bovine pericardial patch is used to close the ventricular septal defect with circumferential 3 − 0 polypropylene sutures. B A Dacron patch is used to repair the myocardial wall with interrupted, pledget-reinforced polypropylene sutures
Fig. 5
Fig. 5
Schematic representation of Daggett’s technique. A Exposure of the ventricular septal defect (VSD) through a ventriculotomy and placement of a pericardial patch to close the defect. B Closure of the VSD with a bovine pericardial patch and the ventriculotomy with a Dacron patch. C Closure of the ventriculotomy
Fig. 6
Fig. 6
Timeline of clinical events
See this image and copyright information in PMC

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