Transcatheter ventricular septal rupture closure: A challenging case of basal inferoseptal aneurysm and rupture

Ventricular septal rupture (VSR) is an ominous mechanical complication of acute myocardial infarction (MI) accompanied with a poor prognosis. Transcatheter closure (TCC) of VSR has been proposed as an alternative approach for surgery. This study presents a 79-year-old man with diabetes mellitus, hypertension, dyslipidemia, and chronic stable angina with 3-vessel coronary artery disease, who had refused a coronary artery bypass graft. He complained of orthopnea and dyspnea of New York Heart Association (NYHA) function class III after the recent neglected inferior MI. Transthoracic echocardiography revealed moderate left ventricular (LV) systolic dysfunction, true aneurysm formation at the base of the inferoseptal wall, as well as a large-sized (12 mm) VSR at the posterior aspect of basal inferoseptal segment with significant left to right shunt and a peak systolic gradient of 50 mm Hg at the VSR site. Given the high risk profile for surgery and patient refusal, he was a candidate for TCC of VSR and staged multi-vessel percutaneous coronary intervention (PCI). A 30 mm Figulla atrial septal defect (ASD) occluder device was chosen and successfully deployed at the VSR site with minimal residual shunt. A month later, successful multi-vessel PCI was performed with good procedural and clinical outcomes on the 6-month follow-up.