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Post-infarct rupture of the membranous ventricular septum complicated by left atrial dissection

matthias.kirsch@hmn.aphp.fr

Keywords: Images in cardiology

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A 56-year old man developed a cardiogenic shock 24 hours after a postero-inferior myocardial infarction. The coronary angiogram revealed a dominant right coronary artery occluded at the origin of its third segment. Transoesophageal echocardiography showed a complex basal ventricular septal rupture at the level of the membranous septum (panels A and B). The rupture was accompanied by an extensive haemorrhage into the muscular ventricular septum and into the interatrial septum, creating a left atrial dissection (panel C).

(A, B) Two dimensional transoesophageal echocardiography showing rupture of the membranous ventricular septum with extensive haemorrhage into its muscular portion and the interatrial septum. (C) Four chamber view with special emphasis on the left atrial wall dissection. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; VSR, ventricular septal rupture.