A 60-year-old man presents 6 hours after onset of anterior STEMI. He undergoes primary PCI and stenting of LAD. Two days later, he develops a new pansystolic murmur at the left sternal border with a thrill. Echo shows a left-to-right shunt at the interventricular septum. What is the most appropriate management?
- A Intra-aortic balloon pump and delayed surgical repair after stabilization ✓
- B Immediate surgical repair of ventricular septal rupture
- C Percutaneous closure device for post-MI VSD
- D ACE inhibitor and diuretic therapy to reduce shunt
Correct answer: A. Intra-aortic balloon pump and delayed surgical repair after stabilization
Explanation
Post-MI ventricular septal rupture (VSR) carries >90% mortality without intervention. If the patient is hemodynamically stable, current guidelines favor stabilization with intra-aortic balloon pump (IABP) or mechanical circulatory support for at least 4–6 weeks before surgical repair, as myocardium needs time to form scar tissue to hold sutures. Immediate surgery in the first days is associated with very high operative mortality. Percutaneous closure is an alternative in select cases, especially for defects that are not suitable for surgery.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.