Table 3 Delayed-diagnosed cases of post-myocardial infarction VSD due to fear of COVID-19 pandemic

Gadre et al. (2021) [49]

1

Worsening back pain

66-year-old woman, with a history of COPD, hypercholesterolemia, and chronic back pain

Inferior STEMI (single vessel disease with RCA occlusion) with no visible VSD at initial evaluation

She became acidotic with respiratory and circulatory failure. Echocardiography revealed a VSD. The family decided to comfort care

Goraya et al. (2021) [50]

1

Worsening SOB and limb edema

53-year-old man, with no known previous disease

Inferior STEMI (multi-vessel disease with RCA occlusion) with a basal inferior wall aneurysm and a small VSD

He underwent removal of mural thrombus, aneurysmectomy, VSD patch repair, and CABG. His hospital course and the 6-month follow-up period were uneventful

Riaz et al. (2023) [51]

1

Acute onset of CP, SOB, and diaphoresis

49-year-old woman, with a history of tobacco use, diabetes, and psychiatric disorders

ST elevations in leads I, II, aVL, and V1-V5 (proximal LAD occlusion) with no visible VSD at initial evaluation

She underwent PCI with DES, but due to the no-reflow phenomenon and hypotension, an IABP was placed. She had a complicated ICU course with COVID-19 pneumonia and cardiogenic shock that was treated appropriately and after improving the symptoms IABP was removed. However, she became hypotensive again and the echocardiography revealed a muscular VSD. She underwent a two-patch technique with bovine pericardium patches for VSD repair that resulted in an improvement of symptoms

Aykent et al. (2022) [52]

1

Worsening SOB and generalized weakness for a week

60-year-old man, with a history of hyperlipidemia and peripheral vascular disease

Inferior STEMI (single vessel disease with RCA occlusion) with large VSD at initial evaluation

An IABP was inserted regarding the management of cardiogenic shock and due to high-risk features, she underwent PCI with DES, and emergent VSD repair was declined. However due to persistent symptoms, ECMO was used and he underwent surgical VSD closure, but unfortunately, 10 days after surgery he expired due to a cardiac arrest

Evans et al. (2022) [53]

1

Worsening SOB and orthopnea

37-year-old man, with a history of hypertension, hyperlipidemia, and hypertriglyceridemia

Anterior STEMI (single vessel disease with LAD occlusion) with large VSD at initial evaluation

He underwent transcatheter VSD closure with an Amplatzer TM post-infarction VSD occlude. The follow-up period was uneventful

Abramo et al. (2022) [54]

7

Acute chest pain

5 men and 2 women with a mean age of 69 (range: 55–78)

Anterior and Posterior STEMI (LAD, LCx, and RCA occlusion). The echocardiographic evaluation demonstrated five posterior and two anterior VSDs.

All patients underwent revascularization (6 PCI and one CABG), surgical VSD repair, and IABP insertion. Most of the patients were discharged uneventfully (unfortunately two patients passed away)

Joshi et al. (2020) [55]

1

Acute onset of CP, lightheadedness, and diaphoresis

72-year-old woman, with a history of hypertension, dyslipidemia, and CAD with prior PCI

Inferior STEMI (single vessel disease with RCA occlusion) with a VSD at initial evaluation

She underwent PCI with DES. Due to poor prognosis and patient wish, VSD surgical repair was declined and she received comfort care.

Okam et al. (2023) [56]

1

Acute onset of CP

92-year-old man, with a history of hypertension, dyslipidemia, CKD, and CAD with prior CABG

Inferior STEMI (RCA occlusion) with second-degree AV block and a VSD at initial evaluation

An IABP was placed for hemodynamic support. However, due to poor prognosis, advanced age, and family decision, VSD surgical repair was declined and he passed away.

Okam et al. (2023) [56]

1

Acute onset left-sided of CP

62-year-old woman, with a history of hypertension, dyslipidemia, and diabetes.

Inferior STEMI (single vessel disease with RCA occlusion) with no visible VSD at initial evaluation

She underwent PCI with DES. Repeated echocardiography revealed a large VSD in the basal aspect of the inferoseptum. She had a complicated hospital course with tamponade, multiorgan failure, and HIT that was managed appropriately. She underwent a VSD closure using the Amplatzer closure device. Additionally, a right ventricular assist device was inserted on hospital day 15. However, due to acidosis and GIB, she became asystole and passed away

Nasso et al. (2025) [13]

8

Acute onset of CP and SOB

5 men and 3 women with a mean age of 64 (range: 42–79). All patients presented with NYHA class IV

STEMI (LAD, LM, LCx, and RCA occlusion). The echocardiographic evaluation demonstrated seven posterior and one anterior VSD.

All of the patients underwent revascularization (three PCI and six CABG, and one combination of PCI and CABG), surgical VSD repair, and IABP insertion. Additionally, 7 patients required ECMO. Half of the patients were discharged uneventfully (unfortunately four patients passed away)