Related Experiment Video
Updated: Jul 2, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Transcatheter Closure of Post-Myocardial Infarction Ventricular Septal Rupture Using an Atrial Septal Defect Occluder
Kanna Nakamura1, Yuta Tsujisaka1, Hiroki Shiomi1
1Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Insights
Transcatheter closure of post-myocardial infarction ventricular septal rupture (VSR) using an atrial septal defect (ASD) occluder is a viable option for inoperable patients. This technique offers an alternative when specialized VSD devices are not available.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Post-myocardial infarction ventricular septal rupture (VSR) is a rare but serious complication.
- Surgical repair of VSR carries high mortality, especially in frail, elderly patients.
- Transcatheter closure presents a less invasive alternative for high-risk surgical candidates.
Objective:
To describe the procedural strategy and technical considerations for transcatheter closure of post-myocardial infarction ventricular septal rupture (VSR) using an atrial septal defect (ASD) occluder in a patient unsuitable for surgical repair.
Key Steps:
An elderly, frail patient with postinfarction VSR and cardiogenic shock was stabilized with an intra-aortic balloon pump. Given the high surgical risk, transcatheter closure was performed after a 14-day delay to allow infarcted tissue stabilization. Multimodality imaging was used to assess defect morphology and rim adequacy. An ASD occluder was deployed under echocardiographic guidance, reducing shunt flow and improving hemodynamics.
Potential Pitfalls:
Wire entrapment in the tricuspid subvalvular apparatus may cause tricuspid regurgitation. Careful wire manipulation and appropriate snaring techniques are essential. Adequate rim assessment is also critical.
Take-Home Message:
Transcatheter VSR closure using an ASD occluder is a feasible alternative in selected inoperable patients, particularly when dedicated VSD devices are unavailable.
