Off-pump repair of a post-infarct ventricular septal defect: the 'Hamburger procedure'

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Cardiac Surgery

Background:

• Post-infarct ventricular septal defects (VSDs) are serious complications of myocardial infarction.
• Traditional surgical repair often requires cardiopulmonary bypass, which carries significant risks for unstable patients.
• Refractory cardiogenic shock in patients with VSDs necessitates alternative, less invasive treatment strategies.

Observation:

• A case report details the peri-operative management of a 76-year-old female patient with an apical VSD.
• The patient presented with refractory cardiogenic shock, making traditional cardiopulmonary bypass-intolerant.
• The 'Hamburger procedure,' an off-pump technique, was employed for VSD closure.

Findings:

• Echocardiography-guided off-pump posterior-anterior septal plication was successfully performed.
• The procedure demonstrated safety and efficacy in closing the post-infarct VSD in this high-risk patient.
• This minimally invasive approach avoided the need for cardiopulmonary bypass.

Implications:

• Off-pump septal plication may be a viable alternative for VSD closure in hemodynamically unstable patients.
• Further clinical experience and studies are needed to validate this technique against traditional patch repairs.
• This approach could expand treatment options for complex cardiac conditions, improving outcomes for high-risk individuals.