Ventricular septal rupture with dissection of the interventricular septum is an extremely rare complication following myocardial infarction, and the optimal surgical strategy remains unclear because of the limited number of surgical cases. Here we report a case of ventricular septal rupture with dissection of the interventricular septum, which we treated using a modification of the extended double patch technique via false lumen incision to close the ventricular septal rupture and exclude the dissection cavity.

The intra-aortic balloon pump (IABP) was first successfully used by Kantrowitz and colleagues in 1968 . Traditionally, IABPs are inserted via the femoral artery. However, this approach is usually contraindicated in patients with severe peripheral vascular disease (PVD). Noël and colleagues were the first to report transbrachial insertion of an 8 Fr IABP catheter for ventricular assistance during percutaneous coronary intervention. However, in almost all the reported cases in which transbrachial insertion of an IABP was performed, it was done for hemodynamic support during percutaneous coronary intervention or coronary artery bypass grafting. We present a case involving a patient with endocarditis-associated structural aortic valve deterioration and severe left ventricular dysfunction, as well as total occlusion of both external iliac arteries. The patient was successfully treated using a 7 Fr transbrachial IABP. A left transbrachial percutaneous approach may thus be a safe and effective alternative if femoral artery access cannot be achieved.