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DOI: http://dx.doi.org/10.21088/jcms.2454.7123.3217.16

Abstract

Background: Post myocardial infarction -Ventricular septal rupture is a fatal condition needing immediate attention. Objectives: This study intends to report a unique angiographic finding – “Winking coronary” sign of infarct related artery (IRA) overlying the ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI). Materials and Methods: Retrospective analysis of 15 patients (mean age - 62.43 ± 8.4 years) having VSR after AMI were included and coronary angiogram of all these patients were evaluated. Thirteen patients had anterior wall and 2 had inferior wall AMI. Results: Majority of the patients had LAD (n=13; 86.7%) and only 13.3% (n=2) had RCA as an involved IRA. None of the patient showed association of LCX as a culprit artery. Only 1 patient had completely occluded IRA, where as all other (n=14; 93.3%) patients showed winking coronary sign on coronary angiogram. In all 4 patients’ who had undergone surgical closure of VSR, the anatomic site of the “wink” was well correlated with the defect at the time of surgery. Conclusions: “Winking coronary” sign of the IRA is sensitive and specific feature of underlying VSR complicating a case of AMI on coronary angiogram.

 

Keywords : Acute Myocardial Infarction; Ventricular Septal Rupture; Infarct Related Artery; Coronary Angiography. 

Corresponding Author : Nilesh Oswal, Senior Consultant, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Ahmedabad, Gujarat 380016, India.