A 70-year-old woman 72 hours after inferior STEMI develops sudden haemodynamic collapse with a new harsh pansystolic murmur best heard at the lower left sternal border and a step-up in oxygen saturation from right atrium to right ventricle on pulmonary artery catheterisation. ECG shows AV dissociation. Which statement is most correct about the surgical timing for the most likely diagnosis?

• A Emergency surgical repair carries prohibitive mortality and medical stabilisation alone is preferred
• B Intra-aortic balloon pump and delayed surgery at 3–6 weeks is the standard approach
• C Transcatheter closure with an Amplatzer device is the preferred first-line approach in this setting
• D Urgent surgical repair despite high operative mortality offers the best long-term survival over conservative management ✓

Explanation

The clinical picture describes a post-infarction ventricular septal defect (VSD) — oxygen step-up RA→RV, pansystolic murmur at LLSB. Although operative mortality is 20–50%, surgical repair is the only definitive treatment and early surgical consultation is warranted; medical management alone carries near-universal mortality. Delaying surgery for 3–6 weeks (to allow fibrous tissue maturation) is preferred by some centres if haemodynamic stability can be maintained, but most guidelines (ACC/AHA) recommend urgent or emergent surgery for haemodynamically unstable patients. Transcatheter closure is used in selected stable patients or as a bridge but is not routine first-line.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.