Ventricular septal rupture and cardiogenic shock complicating STEMI during COVID-19 pandemic: An old foe re-emerges

The COVID 19 pandemic resulted in a total reduction in the number of hospitalizations for acute coronary syndromes. A consequence of the delay in coronary revascularization has been the resurgence of structural complications of myocardial infarctions. Ventricular septal rupture (VSR) complicating late presenting acute myocardial infarction (AMI) is associated with high mortality despite advances in both surgical repair and perioperative management. Current data suggests a declining mortality with delay in VSR repair; however, these patients may develop cardiogenic shock while waiting for surgery. Available options are limited for patients with VSR who develop right ventricular failure and cardiogenic shock. The survival rate is very low in patients with cardiogenic shock undergoing surgical or percutaneous VSR repair. In this study we present two late presenting ST elevation MI patients who were complicated by rapidly declining hemodynamics and impending organ failure. Both patients were bridged with venoarterial extracorporeal membrane oxygenation (ECMO) to cardiac transplant. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

The COVID-19 pandemic led to a decrease in hospitalizations for acute coronary syndromes and a resurgence of structural complications of myocardial infarctions. Delay in VSR repair is associated with declining mortality, but patients may develop cardiogenic shock while waiting for surgery. Limited options are available for patients with VSR complicated by right ventricular failure and cardiogenic shock, with a very low survival rate for those undergoing surgical or percutaneous VSR repair.