Delayed Closure of Ventricular Septal Defect with Prolonged Mechanical Support

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Ventricular septal defect (VSD) following acute myocardial infarction (MI) is a rare but life-threatening mechanical complication.
• High mortality rates (approaching 50%) underscore the need for effective management strategies.
• Delayed presentation and extensive myocardial necrosis contribute to the severity of VSD post-MI.

Purpose of the Study:

• To report a successful case of VSD post-MI treated with a delayed surgical approach.
• To highlight the role of mechanical circulatory support (Impella) in haemodynamic stabilization.
• To emphasize the importance of interdisciplinary collaboration and strategic timing in managing this critical condition.

Main Methods:

• A 58-year-old male with a history of diabetes and hypertension presented with acute anterior MI complicated by VSD.
• Initial haemodynamic support was provided by Impella CP®, followed by angioplasty and stenting of the occluded LAD artery.
• The Impella device was upgraded to Impella 5.5®, and surgery was intentionally delayed for 28 days to allow for myocardial scar formation, followed by successful surgical repair.

Main Results:

• The patient received haemodynamic support with Impella, enabling stabilization prior to definitive surgical repair.
• Delayed surgical intervention, 28 days post-MI, resulted in successful VSD repair with an endocardial patch.
• The patient experienced an uneventful recovery and was discharged with no physical limitations, demonstrating a favourable outcome.

Conclusions:

• Successful management of VSD post-MI requires a multidisciplinary approach, precise surgical timing, and the judicious use of mechanical support devices.
• Delayed surgical repair, facilitated by temporary haemodynamic support, can lead to improved survival rates and functional recovery.
• This case underscores the potential for favourable outcomes with tailored treatment strategies in complex cardiac emergencies.