Hybrid Approach as a Salvage Strategy for Post-Myocardial Infarction Ventricular Septal Defect

Post-myocardial infarction ventricular septal defect (post-MI VSD) is a life-threatening complication of acute myocardial infarction, associated with high mortality if untreated. Advances in surgical repair and percutaneous closure have reduced its incidence, but post-MI VSD remains challenging to manage.

A 67-year-old man with an evolved inferior ST-segment elevation myocardial infarction developed cardiogenic shock. After the diagnosis of post-MI VSD, an initial surgical repair was performed. However, residual ventricular septal defect was detected, likely because of patch dehiscence, along with an additional serpiginous septal defect. After discussion within the heart team, a decision was made to proceed with percutaneous closure of the defect using an Amplatzer vascular plug II (Abbott), achieving an excellent clinical outcome.

A hybrid approach combining surgery and percutaneous intervention for post-MI VSD demonstrates successful outcomes, especially when reoperation poses high risk. This approach could improve management and survival in complex post-MI VSD cases.