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Delayed amplatzer occluder device closure of postinfarction ventricular septal defect: a case report
Francis Ting1, Aditya Bhat2, Neville Sammel1
1St Vincent's Hospital Sydney, NSW 2010, Australia.
Insights
Postinfarction ventricular septal defect (VSD) is a rare but serious complication of heart attack. Percutaneous VSD closure offers a viable alternative to surgery, especially for elderly patients with comorbidities.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Postinfarction ventricular septal defect (VSD) is a rare but life-threatening complication of acute myocardial infarction.
- It carries a high mortality rate, with traditional surgical repair associated with significant perioperative risks.
Purpose of the Study:
- To evaluate the feasibility and success of percutaneous transcatheter closure for postinfarction VSD in an elderly patient.
- To highlight an alternative treatment option for patients unsuitable for conventional surgery.
Main Methods:
- Case report of an 87-year-old female with postmyocardial infarction VSD and heart failure.
- Successful percutaneous closure of the VSD using a 16 mm Amplatzer occluder device.
- The procedure was performed 18 months after the initial myocardial infarction.
Main Results:
- The patient, who was reluctant to undergo open repair due to age and comorbidities, experienced a successful percutaneous VSD closure.
- This demonstrates the potential of transcatheter closure as a treatment option in high-risk patients.
Conclusions:
- Percutaneous transcatheter closure of postinfarction VSD is a safe and effective alternative to surgical repair, particularly in elderly patients with significant comorbidities.
- Further long-term studies are needed to fully ascertain survival data and long-term outcomes.
Abstract:
Postinfarction ventricular septal defect (VSD) is a rare complication after acute myocardial infarction, with an incidence rate of 1-2% of all myocardial infarcts (Hutchins, 1979). It is a medical emergency with sobering survival numbers, having a mortality rate of 70-80% within two weeks of the incident event (Bouchart et al., 1998). Cardiac surgery is considered the gold standard in the management of these defects; however, its main limitation is that it carries a high risk of perioperative mortality and postoperative sequelae. Percutaneous transcatheter closure of VSD is a relatively new method of repair. Due to scarcity of reports in the literature, there is limited data regarding survival data; however, noninferiority to surgery has been demonstrated in one case series (Papalexopoulou et al., 2013). Long-term follow-up studies are lacking, and thus long-term mortality has yet to be discerned. We present a case of an 87-year-old female who, following postmyocardial infarction VSD, developed clinically significant heart failure. The patient was reluctant to undergo open repair given her age and comorbidities and she underwent successful percutaneous repair of her VSD using a 16 mm Amplatzer occluder device 18 months after her initial presentation.
