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?
□ (A) Ventricular septal defect
□ (B) Atrial septal defect
□ (C) Mitral stenosis
□ (D) Tricuspid stenosis
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 repair of post-AMI VSD has been shown to be a viable option for treating smaller post-AMI VSDs.
AMI does not cause atrial septal rupture. Myocardial ischemia may lead to papillary muscle rupture and severe mitral regurgitation, but not mitral stenosis. AMI does not cause tricuspid stenosis.
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