Introduction Ventricular septal rupture (VSR) is a rare mechanical complication of myocardial infarction, often occurring in the anteroseptum , leading to cardiogenic shock. The definitive treatment is surgical repair. This report describes a rare type of VSR that was successfully managed.

Case Presentation We report the case of a 57-year-old male, an active smoker with no known medical history, who presented with a one-week history of breathlessness and orthopnoea. Upon admission, the patient was in hemodynamic compromise, with a blood pressure of 80/60 mmHg, requiring oxygen and inotropic support. Physical examination revealed a loud systolic murmur over the left sternal edge, a loud P2 component, and a parasternal heave. An urgent echocardiogram identified a VSR at the inferoseptum with a left-to-right shunt, a maximum velocity of 3.4 m/s, and a defect measuring 3 cm, along with signs of right ventricular infarction. The patient was immediately taken for a coronary angiogram with intra-aortic balloon pump support followed by urgent operation. Intraoperatively, the inferior RV wall was dilated. There was an aneurysmal space, connected to LV through large VSR 3×4 cm with surrounding bruised tissue, and connected to RV wall through small opening in between RV trabeculae. The VSR was closed with double patch technique using bovine pericardium and prolene 3/0 suture. Postoperatively, the patient experienced transient dialysis-dependent acute kidney injury but was eventually discharged in stable condition.

Discussion This case is notable for the patient’s survival, despite the high fatality rate associated with VSR, particularly in those presenting with cardiogenic shock. The time from diagnosis to surgery was 48 hours—a significant delay—yet the patient’s outcome was favourable. The involvement of a posterior VSR typically reduces survival chances, but effective multidisciplinary management likely contributed to the success of this case. An early notification to the anaesthesiology and cardiothoracic teams, along with the proactive placement of an intra-aortic balloon pump during the coronary angiogram to anticipate potential hypotension, likely contributed to the successful outcome in this case. Additional factors include younger age and good premorbid status of the patient.

Conclusion Post-infarction VSR is a life-threatening condition, but imminent fatality can be prevented with prompt and decisive management.