Abstract

Background: Ventricular septal rupture (VSR) is a rare but catastrophic mechanical complication of acute myocardial infarction (AMI), occurring in approximately 0.3% of cases. Despite advances in reperfusion therapy, VSR remains associated with high morbidity and mortality, particularly in patients with cardiogenic shock. The optimal timing for surgical intervention is debated, and the choice of surgical technique is crucial to improving outcomes. The "sandwich technique," which involves placing patches on both the left and right ventricular sides, has shown superior durability compared to traditional single-patch closure.

Case Report: We present two cases of post-myocardial infarction VSR successfully treated with the sandwich technique. The first case involved a 58-year-old woman with anterior STEMI complicated by VSR, which progressed despite percutaneous coronary intervention (PCI). Surgical closure using the sandwich technique led to a successful outcome. The second case was a 41-year-old man with inferior-posterior STEMI and VSR, requiring intra-aortic balloon pump (IABP) support before surgical repair. Both patients recovered well postoperatively and were discharged in stable condition.

Conclusions: These cases highlight the complexity of VSR management and the importance of individualized treatment strategies. The sandwich technique provides a robust and durable repair option, particularly in cases with friable infarcted myocardium. Additionally, mechanical circulatory support, such as IABP, plays a crucial role in stabilizing patients before definitive intervention. A multidisciplinary Heart Team approach is essential in optimizing outcomes for this life-threatening condition.