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Post-Myocardial Infarction Ventricular Septal Defect Closure by a Percutaneous Septal Occluder Device After
Alberto Boi1, Daniele Cocco1, Francesco Sanna1
1Interventional Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy.
Insights
This case report details a novel percutaneous closure of a post-myocardial infarction ventricular septal defect (VSD) after surgical repair failure. An off-label device successfully treated the complex VSD, offering a life-saving option.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Post-myocardial infarction ventricular septal defect (VSD) is a severe complication of ST-elevation myocardial infarction (STEMI).
- Urgent VSD closure is recommended due to high mortality, but early surgical repair often yields poor outcomes.
- This case highlights the challenges in managing VSD after failed surgical intervention.
Abstract:
Post myocardial infarction ventricular septal defect (VSD) is a life-threatening complication following ST elevation myocardial infarction (STEMI). Current guidelines recommend the urgent VSD closure for its significant mortality. Despite VSD is generally treated by surgical repair, surgeons often refrain from early surgery due to extremely poor results. We report the case of a 76-year-old women admitted to our hospital for a subacute myocardial infarction complicated by acute heart failure with VSD and apical thrombosis. The patient underwent an urgent surgical repair of VSD with a bovine pericardium patch and concomitant double saphenous vein graft for the left anterior descending and the first diagonal branch. After two days an early surgical patch dehiscence was observed and a percutaneous closure was planned. Due to the particular morphology of the unnatural anatomy of the septum generated by the dehiscence, we decided to close the defect using an off-label device for ventricular rupture. A 30/30 mm Amplatzer ASD-MF occluder was successfully implanted. At one-year follow up the patient was alive without significant residual shunt.
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