Keyword: Intra-Aortic Balloon Pump

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.