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Management of Post-Myocardial Infarction Ventricular Septal Defects.

Vincenzo Castiglione1, Marta Casula2, Cataldo Palmieri3

  • 1Fondazione Toscana Gabriele Monasterio, Pisa and Massa, Italy; Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.

The American Journal of Cardiology
|March 4, 2026
PubMed
Summary
This summary is machine-generated.

Post-myocardial infarction ventricular septal defect (post-MI VSD) is a rare complication requiring multidisciplinary care. Surgical repair is preferred, but percutaneous and mechanical circulatory support (MCS) offer alternative strategies for managing this life-threatening condition.

Keywords:
mechanical circulatory supportmyocardial infarctionventricular septal defect

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Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Post-myocardial infarction ventricular septal defect (post-MI VSD) is a rare, life-threatening complication with high early mortality.
  • Despite advances in reperfusion therapy, management remains challenging, necessitating multidisciplinary decision-making.

Purpose of the Study:

  • To conduct a narrative review of surgical, percutaneous, and mechanical circulatory support (MCS) strategies for post-MI VSD.
  • To synthesize current evidence and expert opinion on managing post-MI VSD.

Main Methods:

  • Narrative literature review using PubMed, Scopus, and Google Scholar up to May 2024.
  • Focus on surgical techniques (Daggett, David, double-patch), percutaneous closure devices, and MCS (IABP, VA-ECMO, Impella).

Main Results:

  • Surgical repair is the gold standard, with delayed surgery (>7 days) associated with better outcomes in stable patients.
  • Percutaneous closure is an option for high-risk patients, potentially as a bridge to surgery, though residual shunts can occur.
  • MCS aids hemodynamic stabilization, enabling myocardial recovery before definitive repair; in-hospital mortality remains high, especially with acute interventions.

Conclusions:

  • Management of post-MI VSD requires individualized strategies based on patient stability, defect anatomy, and institutional expertise.
  • Surgical closure offers superior long-term outcomes, while percutaneous and hybrid approaches expand therapeutic options.
  • Future research should focus on optimal timing, patient selection, and the impact of advanced MCS on survival and recovery.