In 1847, Latham first mentioned the diagnosis of ventricular septal rupture (VSR). The interventricular septum divides the ventricular chamber into right and left ventricles.
The interventricular septum consists of 2 parts, i.e., the muscular part and the membranous part.
Muscular part: It comprises the majority of the septum, is present inferior to the membranous part, and is thick. It is derived from the bulboventricular flange.
Membranous part: It comprises a minor portion of the septum, is present superior to the muscular part, and is thin. It is derived from neural crest cells.
A rare but lethal complication of acute myocardial infarction is a ventricular septal rupture. Today, the condition is rare because of an aggressive approach towards early reperfusion therapy; however, mortality is still high. Any part of the interventricular septum can develop a rupture. The size of the rupture determines the prognosis of the patient. The prognosis is good if the rupture is small and the patient is hemodynamically stable.
VSR tends to occur within the first week after acute myocardial infarction. In most cases, there is an immediate decline in hemodynamics which can lead to cardiogenic shock. VSR is a surgical emergency needing immediate treatment in symptomatic patients. The procedure requires the closure of the VSR and coronary artery bypass grafting. Surgery in almost all cases is performed via a transinfarct approach. Prosthetic material is used to close the septum and the ventricular wall to avoid tension. Over the years, better surgical techniques and improved pharmacological and mechanical support have led to good outcomes.
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