Post-myocardial Infarction Ventricular Septal Defect in the Setting of No-Reflow and COVID

The occurrence of post-myocardial infarction (MI) ventricular septal defect (VSD) is a rare but lifethreatening complication. This case report presents a unique case of a 49-year-old female patient with an anterolateral ST-segment elevation MI who underwent percutaneous coronary intervention (PCI) and drugeluting stent (DES) placement, complicated by a no-reflow phenomenon in the distal left anterior descending artery (LAD) and subsequent development of a hemodynamically significant VSD. Notably, this case occurred during the COVID-19 pandemic, which added to the complexity of the patient's management. The patient's clinical course was further complicated by cardiogenic shock, acute respiratory failure, COVID19 pneumonia, and gastrointestinal bleeding. Despite these challenges, the patient received prompt treatment and optimal medical management, including the use of vasopressor support, insulin therapy, and bicarbonate infusions. The patient also underwent surgical repair of the VSD at a quaternary center, resulting in a favorable outcome. This case report highlights the increased incidence of mechanical complications, such as VSD, during the COVID-19 pandemic due to delayed presentation and patient concerns about exposure to the virus. It also emphasizes the occurrence of a no-reflow phenomenon during PCI, which can lead to adverse outcomes, including larger infarct size and potential ventricular septal rupture. The case further underscores the importance of multidisciplinary collaboration and early subspecialist involvement in managing complex cases of post-MI VSD.