An endoscopic repair of residual post-myocardial infarction ventricular septal defect

Abstract Post-myocardial infarction (MI) ventricular septal defect (VSD) is a serious condition that is, fortunately, less diagnosed nowadays due to the advances in early diagnosis and treatment of ischaemic heart disease (incidence 1–2%). Despite the lower mortality of both surgical and interventional closure of the defect (25%) as compared to medical therapy (40–50%), there are still risks of residual leak in both approaches. Herein, we describe a case of a successful endoscopic-assisted repair of a delayed residual leak post-MI VSD after surgical repair. An attempt for interventional closure of the leaking point had failed; an endoscopic-assisted minimal access closure was successfully performed.

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POST-MYOCARDIAL INFARCTION VENTRICULAR SEPTAL DEFECT - TRANSCATHETER VERSUS SURGICAL REPAIR

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03858-4 ◽

2021 ◽

Vol 77 (18) ◽

pp. 2503

Author(s):

Alisha F. Alabre ◽

Eric Kellett ◽

M. Wesley Milks

Keyword(s):

Myocardial Infarction ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Surgical Repair ◽

Post Myocardial Infarction

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Concomitant transcatheter closure of post-myocardial infarction ventricular septal defect and inferior wall aneurysm: case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa408 ◽

2020 ◽

Author(s):

Reda Abuelatta ◽

Tarek Alrashidy ◽

Fatma Taha ◽

Hesham Abdo Naeim

Keyword(s):

Myocardial Infarction ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Surgical Repair ◽

Transcatheter Closure ◽

Percutaneous Closure ◽

Post Myocardial Infarction ◽

Definitive Treatment ◽

Inferior Wall ◽

Amplatzer Septal Occluder

Abstract Background The incidence of the post-infarct ventricular septal defect (VSD) is 0.17%. Surgical repair is the definitive treatment and percutaneous closure is an alternative in high-risk patients. We report a case of post-myocardial infarction inferior wall aneurysm associated with a large ventricular septal rupture, with a communication between the aneurysm and right ventricle. Successful percutaneous closure of both the aneurysm and the post-infarct (VSD) was performed using two Amplatzer septal occluder devices. Case summary A 76-year-old man was referred to the clinic 2 weeks after an inferior wall myocardial infarction. A harsh, pansystolic murmur was appreciated on his left parasternal area and across the pericardium. An echocardiogram demonstrated a large, true aneurysm in the mid-cavity inferior wall. The inferior septum was ruptured and dissected, with a large, left-to-right shunt. The patient’s coronary angiography revealed a multi-vessel disease. The patient was considered as high surgical risk and thus transcatheter closure of both the post-infarct VSD and inferior wall aneurysm was recommended. We crossed the VSD from the venous side. An Amplatzer septal occluder (18 mm) was deployed to close the VSD completely. We crossed the aneurysm mouth from the arterial side. Another Amplatzer septal occluder (26 mm) was deployed with the large disc inside the aneurysm, sealing it with no more flow. After discharge from the intensive care unit, the patient underwent complete revascularization for his right coronary artery, left main artery, proximal left anterior descending artery, and ramus intermedius. At his 3-month follow-up, the patient remained well with reasonable exercise tolerance. Discussion Percutaneous closure of a post-infarct VSD and aneurysm is an option for patients whose comorbidities preclude surgical repair and whose septal anatomy is favourable to device placement.

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