Management of Post-Myocardial Infarction Ventricular Septal Defects

Post-myocardial infarction ventricular septal defect (post-MI VSD) is a rare but life-threatening complication, with an incidence of approximately 0.3% and high early mortality despite advances in reperfusion therapy. Management remains challenging and requires multidisciplinary decision-making. We conducted a narrative review of the literature through May 2024 using PubMed, Scopus, and Google Scholar, focusing on surgical, percutaneous, and mechanical circulatory support (MCS) strategies for post-MI VSD. A narrative approach was adopted due to the rarity of the condition, the heterogeneity of available evidence, and the predominance of registries and case series. Surgical repair remains the gold standard, employing approaches such as the Daggett, David, and double-patch infarct exclusion techniques. Delayed surgery (>7 days) in hemodynamically stable patients is associated with improved outcomes, whereas urgent intervention is warranted in refractory shock. Percutaneous closure, using dedicated or adapted occluder devices, offers an option for high-risk or unstable patients, either as definitive therapy or as a bridge to surgery, though residual shunts are more common. Hybrid procedures and novel beating-heart techniques have shown promise in selected cases. MCS, including intra-aortic balloon pump, veno-arterial extracorporeal membrane oxygenation, and Impella, facilitates hemodynamic stabilization, allowing myocardial recovery before repair. Overall, in-hospital mortality remains high, particularly in acute-phase interventions. In conclusion, management of post-MI VSD demands individualized strategies integrating patient stability, defect anatomy, and institutional expertise. While surgical closure offers superior long-term outcomes, percutaneous and hybrid approaches expand therapeutic options. Future studies should clarify optimal timing, refine patient selection, and evaluate the impact of advanced MCS strategies on survival and recovery.