From the Guidelines
Yes, septal bounce can occur with ventricular septal rupture (VSR). Septal bounce refers to an abnormal motion of the interventricular septum, typically characterized by a bidirectional movement during diastole. In the context of VSR, the septal bounce occurs due to the sudden pressure and volume changes between the ventricles. When the septum ruptures, blood shunts from the left ventricle to the right ventricle during systole, creating abnormal pressure gradients. This hemodynamic disturbance alters the normal septal motion, resulting in the characteristic bouncing movement visible on echocardiography. The severity of the septal bounce often correlates with the size of the rupture and the magnitude of the left-to-right shunt. According to the 2013 ACCF/AHA STEMI Guideline 1, ventricular septal rupture occurs most often within the first 24 hours in patients with STEMI treated with fibrinolytic therapy, and emergency surgical repair is necessary, even in hemodynamically stable patients. Clinicians should be aware that while septal bounce is more commonly associated with constrictive pericarditis and right ventricular volume overload conditions, its presence in the setting of acute myocardial infarction should raise suspicion for VSR, especially when accompanied by a new systolic murmur and hemodynamic instability. Key points to consider in the management of VSR include:
- Emergency surgical repair is necessary, even in hemodynamically stable patients
- Temporizing medical treatment consists of inotropic and vasodilator agents, with IABP when needed
- Percutaneous closure is a less invasive option that might allow for initial hemodynamic stabilization, but experience with this approach is limited, and residual shunts are common, as noted in the guideline by O’Gara et al 1.
From the Research
Septal Bounce and Ventricular Septal Rupture
- There is no direct evidence in the provided studies that discusses the occurrence of septal bounce with ventricular septal rupture.
- However, the studies focus on the management, outcomes, and risk factors associated with ventricular septal rupture (VSR) after myocardial infarction (MI) 2, 3, 4, 5, 6.
- The pathophysiology of VSR involves myocardial necrosis, inflammatory response, and enzymatic degradation of the extracellular matrix, leading to structural weakening and subsequent rupture of the ventricular septum 2.
- The management of VSR requires a multidimensional approach, including risk stratification, surgical timing, pharmacological interventions, minimally invasive techniques, and tissue engineering 2.
- The studies highlight the importance of early surgical repair, risk stratification, and optimization of surgical outcomes in improving patient survival and reducing morbidity 3, 4, 5, 6.
- Despite the lack of direct evidence on septal bounce, the provided studies offer insights into the complexities of VSR and the need for a comprehensive approach to manage this condition effectively 2, 3, 4, 5, 6.