Ventricular Septal Rupture in ST-Elevation Myocardial Infarct in Low Resource Setting: a case series

  • Suryono Suryono Department of Cardiology, Dr. Soebandi General Hospital, Faculty of Medicine, University of Jember, Jember, Indonesia
  • Naesilla Naesilla Kaliwates General Hospital, Jember, Indonesia
  • Jarwoto Roestanajie Dr. Soebandi General Hospital, Jember, Indonesia
  • Dwi Ariyanti Department of Cardiology, Dr. Soebandi General Hospital, Faculty of Medicine, University of Jember, Jember, Indonesia
  • Pipiet Wulandari Department of Cardiology, Dr. Soebandi General Hospital, Faculty of Medicine, University of Jember, Jember, Indonesia
Keywords: myocardial infarct, mechanical complications, predictors, ventricular septal rupture


Background: The mortality rate caused by myocardial infarct (MI) escalates in the presence of ventricular septal rupture (VSR). This article aimed to analyze clinical factors that might be valuable as predictors of VSR.

Case Illustration: We found and presented six documented post-infarction VSR out of 1,613 MI cases between January 2015 to December 2019.

Conclusion: Based on the analysis, clinicians should be aware of these factors as they were potential to be the predictors: advanced age, first MI, anterior location of the infarct, infranodal conduction disorder, no reperfusion treatment, high systolic blood pressure on admission, and no smoking history.


Download data is not yet available.


1. World Health Organization. Chapter 1: Burden : mortality , morbidity and risk factors. Glob Status Rep non-communicable Dis 2010. 2011.
2. Dharma S, Juzar DA, Firdaus I, Soerianata S, Wardeh AJ, Jukema JW. Acute myocardial infarction system of care in the third world. Netherlands Hear J. 2012;20:254-259.
3. Dharma S, Andriantoro H, Dakota I, Purnawan I, Pratama V, Isnanijah H, Yamin M, Bagus T, Hartono B, Ratnaningsih E, Suling F, Basalamah MA. Organisation of reperfusion therapy for STEMI in a developing country. Open Hear. 2015;2:e000240.
4. Gao XM, White DA, Dart AM, Du XJ. Post-infarct cardiac rupture: Recent insights on pathogenesis and therapeutic interventions. Pharmacol Ther. 2012;134:156-179.
5. Qian G, Liu H Bin, Wang JW, Wu C, Chen YD. Risk of cardiac rupture after acute myocardial infarction is related to a risk of hemorrhage. J Zhejiang Univ Sci B. 2013;14:736-742.
6. López-Sendón J, López de Sá E. Mechanical complications of myocardial infarction. In: Tubaro M, Vranckx P, eds. The ESC Textbook of Intensive and Acute Cardiovascular Care. 2nd ed. New York: Oxford University Press; 2014:398-408.
7. Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS, Vahanian A, Califf RM, Topol EJ. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. Circulation. 2000;101:27-32.
8. Moreyra AE, Huang MS, Wilson AC, Deng Y, Cosgrove NM, Kostis JB. Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction. Am J Cardiol. 2010;106:1095-1100.
9. López-Sendón J, Gurfinkel EP, Lopez De Sa E, Agnelli G, Gore JM, Steg PG, Eagle KA, Cantador JR, Fitzgerald G, Granger CB. Factors related to heart rupture in acute coronary syndromes in the global registry of acute coronary events. Eur Heart J. 2010;31:1449-1456.
10. Jones BM, Kapadia SR, Smedira NG, Robich M, Tuzcu EM, Menon V, Krishnaswamy A. Ventricular septal rupture complicating acute myocardial infarction: A contemporary review. Eur Heart J. 2014;35:2060-2068.
11. Birnbaum Y, Fishbein MC, Blanche C, Siegel RJ. Ventricular septal rupture after acute myocardial infarction. N Engl J Med. 2002;347:1426-1432.
12. Menon V, Webb JG, Hillis LD, Sleeper LA, Abboud R, Dzavik V, Slater JN, Forman R, Monrad ES, Talley JD, Hochman JS. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: A report from the SHOCK Trial Registry. J Am Coll Cardiol. 2000;36:1110-1116.
13. Figueras J, Alcalde O, Barrabés JA, Serra V, Alguersuari J, Cortadellas J, Lidon RM. Changes in hospital mortality rates in 425 patients with acute ST-elevation myocardial infarction and cardiac rupture over a 30-year period. Circulation. 2008;118:2783-2789.
14. Ruiz-Bailén M, Expósito-Ruiz M, Castillo-Rivera AM, Rucabado-Aguilar L, Ruiz-García MI, Ramos-Cuadra JÁ, Ruiz-Valverde A, Gómez-Jiménez J, Benitez-Parejo JL, de la Hoz JC, Felices Abat F, Valenzuela JP, ARIAM Group. Heart rupture predictors in Spanish myocardial infarction patients: Evaluation using propensity score analysis. Med Sci Monit. 2010;16:PH49-PH56.
15. Shamshad F, Kenchaiah S, Finn P V., Soler-Soler J, McMurray JJV, Velazquez EJ, Maggioni AP, Califf RM, Swedberg K, Kober L, Belenkov Y, Varshavsky S, Pfeffer MA, Solomon SD. Fatal myocardial rupture after acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: The VALsartan in Acute myocardial iNfarcTion Trial (VALIANT). Am Heart J. 2010;160:145-151.
16. Qian G, Wu C, Chen Y dai, Tu C chen, Wang J wen, Qian Y an. Predictive factors of cardiac rupture in patients with ST-elevation myocardial infarction. J Zhejiang Univ Sci B. 2014;15:1048-1054.
17. Kytö V, Sipilä J, Rautava P. Gender, age and risk of ST segment elevation myocardial infarction. Eur J Clin Invest. 2014;44:902-909.
18. Dharma S, Andriantoro H, Purnawan I, Dakota I, Basalamah F, Hartono B, et al. Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry. BMJ Open. 2016;6:e012193.
19. Tong J, Xiang WW, Ang AS, Sim WJ, Quah KH, Foo D, Ong PJL, Ho HH. Clinical outcomes of elderly South-East Asian patients in primary percutaneous coronary intervention for ST-elevation myocardial infarction. J Geriatr Cardiol. 2016;13:830-835.
20. Qanitha A, Uiterwaal CSPM, Henriques JPS, Alkatiri AH, Mappangara I, Mappahya AA, Patellongi I, De Mol BAJM. Characteristics and the average 30-day and 6-month clinical outcomes of patients hospitalised with coronary artery disease in a poor South-East Asian setting: The first cohort from Makassar Cardiac Center, Indonesia. BMJ Open. 2018;8:e021996.
21. Serpytis P, Karvelyte N, Serpytis R, Kalinauskas G, Rucinskas K, Samalavicius R, Ivaska J, Glaveckaite S, Berukstis E, Tubaro M, Alpert JS, Laucevičius A. Post-infarction ventricular septal defect: Risk factors and early outcomes. Hell J Cardiol. 2015;56:66-71.
22. Liu Z, Pericak-Vance MA, Goldschmidt-Clermont P, Seo D, Wang L, Rundek T, Beecham GW. Coronary collateralization shows sex and racial-ethnic differences in obstructive artery disease patients. PLoS One. 2017;12:e0183836.
23. Prêtre R, Rickli H, Ye Q, Benedikt P, Turina MI. Frequency of collateral blood flow in the infarct-related coronary artery in rupture of the ventricular septum after acute myocardial infarction. Am J Cardiol. 2000;85:497-499.
24. Qiu H, Depre C, Vatner SF, Vatner DE. Sex differences in myocardial infarction and rupture. J Mol Cell Cardiol. 2007;43:532-534.
25. Meyer MR, Bernheim AM, Kurz DJ, O’Sullivan CJ, Tüller D, Zbinden R, Rosemann T, Eberli FR. Gender differences in patient and system delay for primary percutaneous coronary intervention: current trends in a Swiss ST-segment elevation myocardial infarction population. Eur Hear J Acute Cardiovasc Care. 2019;8:283-290.
26. Meier P, Schirmer SH, Lansky AJ, Timmis A, Pitt B, Seiler C. The collateral circulation of the heart. BMC Med. 2013;11:143.
27. Meier P, Hemingway H, Lansky AJ, Knapp G, Pitt B, Seiler C. The impact of the coronary collateral circulation on mortality: A meta-analysis. Eur Heart J. 2012;33:614-621.
28. Skehan JD, Carey C, Norrell MS, De Belder M, Balcon R, Mills PG. Patterns of coronary artery disease in post-infarction ventricular septal rupture. Br Heart J. 1989;62:268-272.
29. Kyriakides ZS, Kremastinos DT, Michelakakis NA, Matsakas EP, Demovelis T, Toutouzas PK. Coronary collateral circulation in coronary artery disease and systemic hypertension. Am J Cardiol. 1991;67:687-690.
30. Yetkin E, Topal E, Erguzel N, Senen K, Heper G, Waltenberger J. Diabetes mellitus and female gender are the strongest predictors of poor collateral vessel development in patients with severe coronary artery stenosis. Angiogenesis. 2015;18:201-207.
31. Shen Y, Ding FH, Dai Y, Wang XQ, Zhang RY, Lu L, Shen WF. Reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion. Cardiovasc Diabetol. 2018;17.
32. Zbinden R, Zbinden S, Billinger M, Windecker S, Meier B, Seiler C. Influence of diabetes mellitus on coronary collateral flow: An answer to an old controversy. Heart. 2005;91:1289-1293.
33. Koerselman J, de Jaegere PPT, Verhaar MC, van der Graaf Y, Grobee DE, Algra A, Rutten GEHM, Banga JD, Visseren FLJ, Eikelboom BC, Moll FL, Kapelle LJ, Koomans HA, Mali WPTM, Doevendans PAFM. High blood pressure is inversely related with the presence and extent of coronary collaterals. J Hum Hypertens. 2005;19:809-817.
34. Abrignani MG, Dominguez LJ, Biondo G, Di Girolamo A, Novo G, Barbagallo M, Braschi A, Braschi G, Novo S. In-hospital complications of acute myocardial infarction in hypertensive subjects. Am J Hypertens. 2005;18:165-170.
35. Koerselman J, de Jaegere PPT, Verhaar MC, Grobbee DE, van der Graaf Y. Coronary collateral circulation: The effects of smoking and alcohol. Atherosclerosis. 2007;191:191-198.
36. Mariani S, Formica F, Paolini G. Mechanical Complications of Myocardial Infarction. In: Kirali K, ed. Coronary Artery Disease - Assessment, Surgery, Prevention. IntechOpen; 2015:215-244.
37. Vargas-Barrón J, Molina-Carrión M, Romero-Cárdenas Á, Roldán FJ, Medrano GA, Ávila-Casado C, Martínez-Ríos MA, Lupi-Herrera E, Zabalgoitia M. Risk factors, echocardiographic patterns, and outcomes in patients with acute ventricular septal rupture during myocardial infarction. Am J Cardiol. 2005;95:1153-1158.
38. Sundeep Viswanathan and Marin Kollef. Cardiac Arrhythmias and Conduction Abnormalities. In: Kollef MH, Isakow W, eds. The Washington Manual of Critical Care. 2nd ed. Philadelphia: Wolters Kluwer; 2012:125-154.
39. Wong CK, Stewart RAM, Gao W, French JK, Raffel C, White HD. Prognostic differences between different types of bundle branch block during the early phase of acute myocardial infarction: Insights from the Hirulog and Early Reperfusion or Occlusion (HERO)-2 trial. Eur Heart J. 2006;27:21-28.
40. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll Cardiol. 2013;61:e78-e140.
41. Hayashi T, Hirano Y, Takai H, Kimura A, Taniguchi M, Kurooka A, Ishikawa K. Usefulness of ST-segment elevation in the inferior leads in predicting ventricular septal rupture in patients with anterior wall acute myocardial infarction. Am J Cardiol. 2005;96:1037-1041.
42. Suder B, Janik Ł, Wasilewski G, Konstanty-Kalandyk J, Sadowski J, Kapelak B, Ceranowicz P, Bartuś K. Post-myocardial infarction ventricular septal defect. Is it better to operate on a fresh infarction or to wait? A case study. Kardiochirurgia i Torakochirurgia Pol. 2016;13:39-41.
43. Firstenberg MS, Kissling KT, Nelson K. Management and Controversies of Post Myocardial Infarction Ventricular Septal Defects. In: Firstenberg MS, ed. Principles and Practice of Cardiothoracic Surgery. IntechOpen; 2013:293-319.
44. Poulsen SH, Præstholm M, Munk K, Wierup P, Egeblad H, Nielsen-Kudsk JE. Ventricular Septal Rupture Complicating Acute Myocardial Infarction: Clinical Characteristics and Contemporary Outcome. Ann Thorac Surg. 2008;85:1591-1596.
Views & Downloads
Abstract views: 986   
PDF downloads: 435   
How to Cite
Suryono, S., Naesilla, N., Roestanajie, J., Ariyanti, D., & Wulandari, P. (2021). Ventricular Septal Rupture in ST-Elevation Myocardial Infarct in Low Resource Setting: a case series. Indonesian Journal of Cardiology, 41(4).