Transcatheter device closure of a residual postmyocardial infarction ventricular septal defect

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Post-myocardial infarction ventricular septal defect (VSD) is a serious complication with high mortality.
• Surgical VSD closure can be challenging, with residual defects being common, necessitating further management.
• This case highlights the management of a complex VSD following acute myocardial infarction.

Observation:

• A 75-year-old female presented with acute anterior myocardial infarction, treated with percutaneous coronary intervention.
• Post-procedure, she developed a hemodynamically significant apical anteroseptal VSD with pulmonary hypertension.
• Initial surgical VSD closure and coronary artery bypass grafting were followed by persistent residual shunt and septicemia.

Findings:

• A residual VSD post-surgical closure required a second intervention.
• A 10-mm Cardio-O-Fix septal occluder was successfully deployed under imaging guidance to close the residual defect.
• The patient stabilized hemodynamically with no significant residual shunt after the device closure.

Implications:

• This case demonstrates the feasibility and success of a hybrid approach for managing residual VSDs after initial surgical repair.
• Percutaneous device closure offers a less invasive option for residual shunts, improving patient outcomes.
• Effective management of post-MI VSD, including residual defects, is crucial for reducing mortality in high-risk cardiac patients.