A hole in the septum that divides the left and right chambers of the heart occurring due to heart attack is a rare but life-threatening condition. If not operated 94% of patients die. Even in the best hands, surgery to close such holes due to heart attack in the heart can save only 53% of patients.
The complications of heart holes due to heart attack happens if a patient comes to the hospital 24 hours late after the heart attack. Because of the facilities of emergency angioplasty, holes in the heart due to heart attacks have become very rare (0.3%) now. Though rare it is a lethal complication of a heart attack.
A 51 years old diabetic, hypertensive lady suffered a major heart attack called Acute Anterior wall myocardial infarction. She underwent coronary angiography and angioplasty with stenting to LAD at some other hospital in Faridabad.
She continued to deteriorate even after the procedure. Her BP on arrival at our hospital was very low. 2D Echo revealed a ventricular septal rupture with poor heart function.
The patient’s relatives consulted Dr S.S. Bansal, a senior interventional cardiologist for her further management. She was shifted to SSB Heart and Multispecialty Hospital, Faridabad on 22-06-2021 with a big hole in the septum of the heart. This happened due to severe damage to the septum as a result of a heart attack.
The case was discussed with Chief Cardiac Surgeon, Dr (Brig.) S.S. Sidhu. The Patient was stabilized by using an Intra-Aortic Balloon pump called IABP. She had deteriorating Kidney functions so she was taken for emergency surgery.
She underwent patch repair of a large hole in the septum due to a heart attack and bypass surgery with balloon support by Dr Sidhu, Dr Nilesh Agarwal, Cardiac anaesthesiologist Dr Pankaj Ingole and Dr Neelam Aggarwal.
Post-operatively there was a gradual improvement in blood pressure. The patient was taken off the ventilator and balloon pump on the 3rd post-operative day. The patient recovered very fast after this emergency surgery.
In most cases of post-MI VSD (ventricular septal defect), there is an immediate decline in blood pressure which usually leads to cardiogenic shock and death. Post heart attack VSD is a surgical emergency needing immediate surgical or device closure. This case signifies the role of team efforts, meticulous surgery, and round-the-clock high-end critical care.
Only a dedicated and motivated cardiac and cardiothoracic team can save such high-risk patients, said Dr. S.S. Bansal.