Anaesthetic Considerations for Combined Post-Infarction Ventricular Septal Rupture Repair Using a Novel Transvalvular Technique and Coronary Artery Bypass Grafting: A Case Report

Abstract

Background: Post-infarction ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of myocardial infarction that often necessitates urgent surgical repair. The choice of surgical technique and anaesthetic management is critical for optimizing patient outcomes. Case Presentation: We report the case of a 61-year-old male with post-infarction VSR and multivessel coronary artery disease who underwent combined coronary artery bypass grafting (CABG) and VSR repair using a novel transvalvular double-patch technique. This approach, which avoided left ventriculotomy, preserved myocardial integrity and reduced cardiopulmonary bypass (CPB) duration. Anaesthetic Management: Anaesthetic goals focused on hemodynamic optimization, minimizing shunt flow, and maintaining forward cardiac output. Intraoperative transesophageal echocardiography (TEE) was used continuously to monitor ventricular performance and guide surgical repair. Outcome: Postoperatively, the patient developed complete heart block and required permanent pacemaker implantation. He recovered steadily and was discharged in stable condition on postoperative day 10. Conclusion: This case highlights a novel, myocardial-sparing approach to post-infarction VSR repair when combined with CABG. The technique demonstrates promising perioperative outcomes and could offer a viable alternative to traditional methods. Further studies are needed to assess long-term outcomes and broader applicability.