A heart attack happens when a blood vessel supplying the heart becomes blocked, cutting off oxygen and damaging part of the heart muscle. In some cases, this damage can cause a tear inside the heart, allowing blood to leak the wrong way. This serious complication is called a ventricular septal rupture (VSR).
When it occurs, oxygen-rich blood starts flowing into the wrong chamber of the heart, sending too much blood to the lungs and putting extreme strain on the heart’s pumping ability. If not treated quickly, it can be life-threatening.
To save lives, doctors must:
Centres such as Heart Valve Experts in Mumbai bring together heart specialists, advanced imaging, and modern treatment options to deliver complete, personalised care for patients with this rare emergency.
This guide is for educational purposes and does not replace personalised medical advice. Always consult a qualified cardiologist for individual treatment decisions.
After a heart attack, part of the heart muscle may become so damaged that it weakens and tears. This tear inside the heart is called a ventricular septal rupture (VSR).
VSR typically develops within the first 1-2 weeks after a heart attack, most commonly around days 3-5.
Symptoms of VSR can develop suddenly:
To understand the condition thoroughly and plan the proper treatment, cardiologists use specialised heart imaging tests:
| Diagnostic Test | Description |
| Transthoracic Echocardiography (TTE) | Heart ultrasound performed through the chest wall to detect valve issues and assess blood flow. |
| Transoesophageal Echocardiography (TOE) | Detailed scan using a small probe in the throat to view smaller or deeper tears. |
| Coronary Angiography | X-ray test with contrast dye to detect blocked arteries, performed when the patient’s condition allows. |
Note: These diagnostic steps help doctors stabilise the patient with medications or temporary heart-support devices before proceeding with valve repair.
Once a ventricular septal rupture (VSR) is detected, doctors focus first on stabilising the heart and maintaining blood flow to vital organs. This step helps prepare the patient for a safe, planned repair.
A thin balloon is placed inside the body’s main artery (the aorta). It inflates and deflates in rhythm with the heartbeat, easing the strain on the heart and helping more blood reach the body. By lowering the pressure the heart pumps against, this support also reduces the amount of blood leaking through the tear.
In cases of severe heart failure, doctors may use a temporary life-support system called VA-ECMO. It takes over the job of the heart and lungs, delivering oxygen and circulating blood until the heart is strong enough for surgery or device-based repair.
These measures give doctors crucial time to plan the best approach for closing the rupture under more stable conditions.
When the patient is stable, doctors decide how to close the VSR, either through open-heart surgery or a catheter-based (transcatheter) procedure. Each method has its own advantages and limitations.
| Feature | Surgical Repair | Transcatheter Closure |
| Success Rate | High in stable patients | Good in selected, stable patients |
| In-hospital Mortality | Significant risk, especially in unstable patients | Variable risk depending on patient condition and timing |
| Invasiveness | Open-chest surgery using a heart-lung machine | Performed through a thin tube (catheter) inserted from the groin, no heart-lung machine needed |
| Timing | Usually delayed 7-14 days to allow tissue to heal and strengthen | Can be done earlier in selected cases |
| Tissue Requirement | Needs firm, scarred tissue to hold sutures securely | Requires a clearly defined edge for the closure device |
| Main Benefit | Offers long-term durability and allows simultaneous bypass grafting if required | Less invasive and avoids open-chest surgery |
| Main Limitation | Longer recovery and higher early risk | Possibility of a small residual leak or device-related issues |
Both methods aim to restore the heart’s normal circulation and prevent further damage. The choice depends on the patient’s condition, the location of the tear, and the experience of the medical team.
Choosing the appropriate treatment for post-infarction VSR depends on several factors. Cardiologists evaluate each case carefully, considering the following aspects to balance patient safety with the best possible outcome:
The size and shape of the tear guide the choice of treatment.
Patients with severe lung or kidney problems may benefit more from a catheter-based approach, which avoids complete anaesthesia and the use of a heart-lung machine (cardiopulmonary bypass, CPB).
Treatment outcomes are better at specialized cardiovascular centers with in-house expertise, as such settings minimize the need for revisions or repeat procedures during treatment. Skilled cardiologists can also reduce the risk of complications during device-based interventions.
In some cases, doctors combine support devices such as an intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) with early device closure. This approach helps stabilise the patient before performing definitive surgery under safer conditions.
A multidisciplinary team, including cardiologists, surgeons, anaesthetists, perfusionists, and intensivists, collaborates to decide on the best timing and treatment strategy.
Once the approach is finalised, cardiologists proceed with the selected intervention, either surgical or transcatheter, based on the patient’s stability and defect characteristics.
Ventricular septal rupture after a heart attack is a critical, life-threatening condition. Rapid recognition, early stabilisation, and personalised repair decisions are essential to improve survival and long-term heart function. Care at specialised centres with multidisciplinary heart teams ensures the safest and most effective treatment.
Key considerations for managing post-infarction VSR include:
With careful monitoring, timely intervention, and personalised care, patients have the best chance of recovery while preserving heart function and quality of life.
Yes. Severe heart attacks can cause a tear in the wall between the left and right ventricles, known as a ventricular septal rupture (VSR).
Treatment includes medicines to support blood pressure, mechanical devices such as IABP or VA-ECMO, and emergency procedures to restore blood flow or repair damage.
Unstable patients need urgent surgery. Stable patients are often treated after 7-14 days, when the tissue becomes stronger for repair.
In-hospital mortality remains significant, often higher after surgery than after transcatheter closure, depending on patient stability and timing of treatment.
Recurrence is rare when the repair or device closure is successful, but regular follow-up with echocardiography is essential to ensure the defect remains sealed.
