Case Report:
A 57-year-old man suffered sudden chest pains, mainly in the middle and lower sternum, accompanied by sweating, while he rested at home 4 months ago. He chose to delay medical care because of the COVID-19 epidemic. Three months later, he developed chest tightness, shortness of breath and other discomfort. The symptoms of depression and shortness of breath aggravated significantly after a little activity, complicating systemic edema, especially in the extremities. Physical examination after admission revealed heart rate of 98 beats/min, blood pressure of 131/103mnHg, no rales in both lungs, intermittent rales in the third and fourth ribs and systolic ejection murmur on the left sternal border. Besides, Troponin was 0.01μg/L; CK-MB was 12.8U/L; BNP was 880.6pg/ml. Electrocardiogram indicated myocardial infarction of anterior interwall and anterior wall (Figure 1 A). Color echocardiography revealed abnormal movement of the anterior and interanterior walls of the left ventricle with septal perforation (Figure2 A). Myocardial CT showed myocardial defects at the apex of the ventricular septum, being consistent with myocardial perforation (Figure 3). Coronary angiography revealed a three-vessel lesion.( (Figure4 A)(174)
The patient improved slightly after the treatment of vasodilating, diuresis and heart strengthening. For ventricular septal defect, there was high risk of surgery according to the cardiac surgery consultation. His family members gave up surgical treatment and interventional plugging treatment. The patient was treated with anti heart failure drugs after risk assessment. The patient was followed up in our hospital every 3 months. During the period, his chest tightness, shortness of breath and other symptoms did not worsen. Color echocardiography reveals there was no ventricular septal defect enlargement and cardiac function decline. The patient developed chest tightness, and increased shortness of breath, with significant restrict of activity after 22 months. Physical examination revealed heart rate of 98 beats/min, blood pressure of 131/103mnHg, no rales in both lungs, intermittent rales in the third and fourth ribs and systolic ejection murmur on the left sternal border. Supplementary examination revealed that Troponin and CK-MB were within normal limits. Electrocardiogram indicated old myocardial infarction (Figure1 B). Color echocardiography showed no enlarged perforation (Figure 2 B).
Percutaneous transcatheter closure was chosen after communication with family members (Figure4 B). Postoperative echocardiography showed changes after ventricular septal closure (Figure2 C). After treatment with anti-heart failure and symptomatic support, the patient’s symptoms of chest tightness and shortness of breath were relieved. And he was discharged from the hospital upon recovery.