Post-infarction ventricular septal defect: triggered by Valsalva manoeuvre?

Post–infarction ventricular septal defect (VSD) is a fatal mechanical complication of myocardial infarction. Although the incidence has decreased to less than 1% after the extensive use of reperfusion strategies, post–infarction VSD still carries a high mortality risk. Management is controversial, whether to wait for surgery after a stabilisation period or to perform emergency surgery when diagnosed. We report on a case of post–infarction VSD that was detected with severe haemodynamic instability, beginning immediately after the patient’s Valsalva manoeuvre on the sixth day of a non–reperfused inferior myocardial infarction. In the early period, the post–infarction VSD was repaired via a trans–aneurysmal approach.