Successful percutaneous treatment of recurrent post-infarction ventricular septal rupture using an Amplatzer duct
Masaki Ishiyama1, Tairo Kurita1, Junko Ishiura1
1Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan.
Insights
Percutaneous device closure effectively treated recurrent ventricular septal rupture (VSR) after myocardial infarction in a high-risk patient. This transcatheter approach offers a viable alternative for inoperable cases, improving hemodynamics and recovery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Ventricular septal rupture (VSR) is a rare, life-threatening complication of acute myocardial infarction.
- Early surgical repair is often indicated, but VSR recurrence and reoperation challenges are significant.
- Patients with VSR often present in critical condition, increasing surgical risks.
Abstract:
A 78-year-old woman was brought to our hospital for chest pain with shock status. An electrocardiogram showed ST elevation in the precordial leads. Echocardiography showed an anteroseptal wall motion abnormality with left-to-right shunt at the apex. Emergency coronary angiography revealed occlusion in the mid portion of the left anterior descending artery, and left ventriculography showed ventricular septal rupture (VSR). Despite successful emergency surgical VSR repair, the VSR recurred 10 days after surgery, and the patient required intra-aortic balloon pumping and mechanical ventilation. Although reoperation for VSR closure was attempted 33 days after admission, open heart surgery was not completed due to severe tissue adhesions from the prior cardiac surgery. The patient ultimately underwent transcatheter closure for VSR using an Amplatzer duct occluder 56 days after hospital admission, and her hemodynamics markedly improved. She was transferred to a regional hospital for rehabilitation without oxygen therapy or intravenous treatments 81 days after the percutaneous intervention. In conclusion, percutaneous device closure of post-infarction VSR may be an alternative treatment to surgical repair for inoperable cases. <Learning objective: Ventricular septal rupture (VSR) is a rare but frequently fatal complication of acute myocardial infarction and often requires early surgery. However, the recurrence rate of VSR after surgery is high, and reoperation is often difficult because of the critical nature of the patients' condition. The present case report highlights the effectiveness of percutaneous closure of VSR using Amplatzer devices for seriously ill patients with a high risk of reoperation.>.
