Delayed Repair of an Iatrogenic Perimembranous VSD After Redo Aortic Valve Replacement: Timing Over Urgency

Iatrogenic ventricular septal defect (VSD) is an uncommon complication of redo aortic valve surgery, particularly during prosthesis explantation near the membranous septum.

A 71-year-old woman with a prior 19-mm bioprosthetic aortic valve underwent redo aortic valve replacement for severe prosthetic dysfunction. Explantation created a perimembranous VSD that was initially closed transaortically; intraoperative transesophageal echocardiography showed a trivial residual shunt. On postoperative day 5, transthoracic echocardiography revealed a new 0.5-cm VSD with left-to-right shunting. Emergent transtricuspid patch repair failed because of extreme septal tissue friability. Six weeks later, after fibrotic maturation, left ventricular-side patch closure with concomitant sutureless aortic valve replacement achieved complete closure.

In stable patients, delayed repair of an iatrogenic VSD may enable durable closure when early repair fails because of friable tissue.

Timing of repair may determine surgical success in an iatrogenic VSD.