INTERNATIONAL JOURNAL OF EVIDENCE-BASED MEDICINE
Case Report
Jun 03, 2026 83 20

Delayed Surgical Repair of Post-Infarction Apical Ventricular Septal Rupture Bridged with Intra-Aortic Balloon Pump Support: A Case Report with 1-Year Follow-Up

Zakiur Rehman Abdul Rehman Ansari 1 * ,
Zainul Abedein Hamdulay 2,
Azizullah Khan 3,
Yunus Loya 4,
Sanjesh Jain 5,
Meher Hamdulay 5
1 Department of Clinical Research in Cardiovascular Diseases & Critical Care Medicine, Masina Heart Institute, Mumbai, Maharashtra, India2 Department of Cardiothoracic Surgery, Masina Heart Institute, Mumbai, Maharashtra, India3 Department of Critical Care Medicine, Masina Heart Institute, Mumbai, Maharashtra, India4 Department of Interventional Cardiology, Masina Heart Institute, Mumbai, Maharashtra, India5 Department of Cardiac Anaesthesia, Masina Heart Institute, Mumbai, Maharashtra, India* Corresponding Author
International Journal of Evidence-Based Medicine, 1(1), 2026, jebm003
Publication date: Jun 03, 2026
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ABSTRACT

Post-infarction ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction (MI). We report a 52-year-old male who presented with acute inferior wall ST-elevation MI complicated by cardiogenic shock and a 12-mm apical VSR. Initial serum lactate was 4.8 mmol/L, peaking at 5.7 mmol/L preoperatively, with oliguria, progressive renal dysfunction (peak creatinine 3.0 mg/dL), and hepatic injury (peak AST 1312 U/L; ALT 965 U/L). Coronary angiography revealed 100% distal occlusion of a dominant right coronary artery. Intra-aortic balloon pump (IABP) support was initiated on admission with concurrent vasopressor therapy. Delayed surgical repair was performed on hospital day 8 following recurrent hypoperfusion despite temporary stabilization. Total IABP duration was 11 days. Postoperative echocardiography demonstrated trivial residual shunt with left ventricular ejection fraction (LVEF) of 35%. At 1-year follow-up, the patient remained asymptomatic (NYHA class I) with LVEF 40% and no clinically significant residual shunt. This case illustrates a pragmatic application of serial physiological and end-organ perfusion assessment to help individualize timing of delayed surgical repair in a patient with post-infarction VSR bridged by prolonged IABP support.

KEYWORDS

Ventricular Septal Rupture Myocardial Infarction Cardiogenic Shock Intra-Aortic Balloon Pump Delayed Surgical Repair

CITATION (Vancouver)

Ansari ZRAR, Hamdulay ZA, Khan A, Loya Y, Jain S, Hamdulay M. Delayed Surgical Repair of Post-Infarction Apical Ventricular Septal Rupture Bridged with Intra-Aortic Balloon Pump Support: A Case Report with 1-Year Follow-Up. International Journal of Evidence-Based Medicine. 2026;1(1):jebm003.
APA
Ansari, Z. R. A. R., Hamdulay, Z. A., Khan, A., Loya, Y., Jain, S., & Hamdulay, M. (2026). Delayed Surgical Repair of Post-Infarction Apical Ventricular Septal Rupture Bridged with Intra-Aortic Balloon Pump Support: A Case Report with 1-Year Follow-Up. International Journal of Evidence-Based Medicine, 1(1), jebm003.
Harvard
Ansari, Z. R. A. R., Hamdulay, Z. A., Khan, A., Loya, Y., Jain, S., and Hamdulay, M. (2026). Delayed Surgical Repair of Post-Infarction Apical Ventricular Septal Rupture Bridged with Intra-Aortic Balloon Pump Support: A Case Report with 1-Year Follow-Up. International Journal of Evidence-Based Medicine, 1(1), jebm003.
AMA
Ansari ZRAR, Hamdulay ZA, Khan A, Loya Y, Jain S, Hamdulay M. Delayed Surgical Repair of Post-Infarction Apical Ventricular Septal Rupture Bridged with Intra-Aortic Balloon Pump Support: A Case Report with 1-Year Follow-Up. International Journal of Evidence-Based Medicine. 2026;1(1), jebm003.
Chicago
Ansari, Zakiur Rehman Abdul Rehman, Zainul Abedein Hamdulay, Azizullah Khan, Yunus Loya, Sanjesh Jain, and Meher Hamdulay. "Delayed Surgical Repair of Post-Infarction Apical Ventricular Septal Rupture Bridged with Intra-Aortic Balloon Pump Support: A Case Report with 1-Year Follow-Up". International Journal of Evidence-Based Medicine 2026 1 no. 1 (2026): jebm003.
MLA
Ansari, Zakiur Rehman Abdul Rehman et al. "Delayed Surgical Repair of Post-Infarction Apical Ventricular Septal Rupture Bridged with Intra-Aortic Balloon Pump Support: A Case Report with 1-Year Follow-Up". International Journal of Evidence-Based Medicine, vol. 1, no. 1, 2026, jebm003.

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