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Post myocardial infarction ventricular septal rupture-protracted hemolysis due to missed additional ventricular

Vivek Bagaria1, Channabasavaraj Shivalingaiah Hiremath1

  • 1Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066 India.

Indian Journal of Thoracic and Cardiovascular Surgery
|May 1, 2023
PubMed

Insights

Protracted hemolysis after ventricular septal rupture (VSR) device closure can necessitate surgical intervention. A case revealed a muscular band dividing the VSR, causing a residual shunt and persistent hemolysis.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter device closure is a common treatment for post-myocardial infarction ventricular septal rupture (VSR).
  • Hemolysis is a recognized complication, typically resolving spontaneously.
  • Persistent hemolysis may indicate residual shunting or device-related issues.

Observation:

  • A patient experienced prolonged hemolysis following VSR device closure.
  • Surgical intervention was required for device retrieval and VSR closure.
  • A muscular band was identified, dividing the VSR into two distinct defects.

Findings:

  • The muscular band created a residual shunt through the second VSR defect.
  • This residual shunt was the likely cause of the protracted hemolysis.
  • Surgical patch closure successfully addressed the residual defect and resolved hemolysis.

Implications:

  • This case highlights the importance of thorough anatomical assessment before VSR device closure.
  • Unrecognized complex VSR anatomy, such as septation, can lead to device failure and complications.
  • Surgical revision may be necessary in cases of persistent hemolysis due to residual shunting.
  • This emphasizes the need for careful follow-up after transcatheter VSR closure.

Keywords:
HemolysisPost myocardial infarction ventricular septal ruptureSurgical device retrievalTranscatheter device closure

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