A 65-year-old man is diagnosed with an ST-segment elevation myocardial infarction and is treated with a coronary artery stent. Five days after stent placement, he develops acute-onset shortness of breath. A transesophageal echocardiogram is obtained. Which of the following is the MOST likely diagnosis?

Ventricular septal rupture causing a ventricular septal defect is a well-known complication of acute myocardial infarction (AMI) (Figure). The introduction of thrombolytic therapy in the setting of AMI has reduced the incidence of post-AMI ventricular septal rupture from 2% to 0.2%. Ventricular septal rupture most commonly occurs in the first week after AMI.

Ventricular septal rupture leads to an acute left-to-right shunt and often precipitates cardiogenic shock. Urgent surgical repair has been the standard treatment for post-AMI ventricular septal defect (VSD), as the mortality rate for medical management approaches 90%. More recently, transcatheter...

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