Extremely Late Post-Infarction Ventricular Septal Rupture: A Case Report of Successful Surgical Repair.

Mechanical complications of ST-elevation myocardial infarction have become rare in high-income settings due to timely reperfusion. However, they remain more prevalent and carry a high mortality in regions lacking access to early reperfusion. We present a 62-year-old man with inferior STEMI managed conservatively without reperfusion. At four months, he developed progressive dyspnea. One year later, echocardiography revealed a large basal ventricular septal rupture and severe eccentric mitral regurgitation, all absent at discharge. The patient's transfer to a cardiovascular surgery center was delayed by two years, a consequence of the COVID-19 pandemic. Imaging confirmed an inferobasal left ventricular pseudoaneurysm, basal ventricular septal rupture, severe mitral regurgitation, and a left ventricular ejection fraction of 45%. Right heart catheterization showed a significant left-to-right shunt; coronary angiography revealed multivessel coronary artery disease. He underwent successful surgical repair and remained asymptomatic at the three-year follow-up.