Abstract
Ischemic ventricular septal rupture （VSR） is a rare
but often fatal condition, with surgical closure typically
recommended after a 7–10 days stabilization period.
We report the case of a 77-year-old Jehovah’s Witness
with VSR, where transfusion was not an option due to
religious beliefs. We used Impella CP, landiolol, and
inhaled nitric oxide to achieve stable hemodynamic
support and reduce the workload of the left ventricle.
Despite achieving hemodynamic stability, the surgical
waiting period was shortened to 2 days due to a significant
drop in platelet count. The patient successfully
underwent VSR closure with the extended sandwich
patch technique. This case highlights that Impella can
be a valuable choice for maintaining hemodynamic stability
in ventricular septal rupture （VSR） management.
However, in patients refusing transfusion, careful
preoperative management is essential, not only for
hemoglobin but also for platelet counts and coagulation
parameters.
