Device closure of ‘complex’ postinfarction ventricular septal defect

Abstract

Ventricular septal defect (VSD) is a life-threatening complication of acute myocardial infarction (MI), resulting in high mortality rate even in the case of a timely approach by surgical repair. Transcatheter closure is nowadays a reliable alternative to surgery, although currently deemed challenging or unsuitable in large and complex VSD. This article reports on a successful transcatheter approach in a critically ill patient with subacute right coronary-related, complex postinfarction VSD. In this patient, two sequentially deployed Amplatzer Septal Occluder devices stabilized the clinical conditions and hemodynamic parameters.

Ventricular Septal Defect Complicating Inferior Acute Myocardial Infarction: A Case of Percutaneous Closure

“…Moreover, PC has been used IN hybrid approach, as in case of VSD extension or recurrence, partial patch detachment after primary surgical repair, or in case of dislodgement or embolization of the occluding device. [1] However, PC has also been described as successful definitive treatment,[910] with similar outcomes with respect to cardiac surgery (30-day operative mortality 27%–65% vs. 14%–66% after PC). [1] Several technical challenges have been reported such as friable edge that results in difficult device stabilization and increase embolization risk; necrosis progression, causing difficult selection of device size; proximity to atrioventricular valves and serpiginous defect course, leading to complex procedure steps.…”

“…[1] Several technical challenges have been reported such as friable edge that results in difficult device stabilization and increase embolization risk; necrosis progression, causing difficult selection of device size; proximity to atrioventricular valves and serpiginous defect course, leading to complex procedure steps. [910] However, PC results in sudden shunt reduction and hemodynamic stabilization. Owing to the use of more tailored devices and the technology progress, PC of VSD has been emerged as a valid cost-effective alternative to surgery and should be advised, particularly in critical patients.…”

Hemolysis induced by PMIVSD occluder

“…The role of balloon sizing is controversial in this condition unlike congenital ASD or VSD. If the defect is too much complex, it may need more than one device 15 and procedure can be staged. Till now, the shape of the chosen device is limited to the choice of the individual operator depending upon the 3D shape of defect.…”