Percutaneous Closure of an Iatrogenic Ventricular Septal Defect Following Concomitant Septal Myectomy at the Time of Aortic Valve Replacement

Abstract

A 77-year-old female patient underwent aortic valve replacement (AVR) with concomitant septal myectomy and tricuspid annuloplasty. Her symptoms did not improve after a successful operation. Echocardiogram demonstrated the presence of an iatrogenic ventricular septal defect (VSD). It was muscular in location and not the usual AVR with membraneous type of VSD, suggesting a complication from the myectomy. Percutaneous closure of the VSD remained the only feasible option due to her poor overall medical status. A 14-mm Amplazter VSD occluder was deployed successfully, by means of the trans-septal technique. She has improved very well postoperatively.

(Interventricular septal defect as a complication of a concomitant aortic valve replacement and aortocoronary bypass surgery)

“…publikovali kazuistiku pacienta s VSD po konkomitantnej operácii AVR, myektómii septa a anuloplastike trikuspidálnej chlopne. 12 V prezentovanom prípade bol VSD lokalizovaný vo svalovej časti septa, čo poukazuje na možnú etiológiu ako komplikáciu myektómie, nie AVR. Defekt bol riešený perkutánnou implantáciou okluzora na piaty pooperačný deň.…”

“…Defekt bol riešený perkutánnou implantáciou okluzora na piaty pooperačný deň. 12 Iní autori prezentujú konzervatívny prístup bez nutnosti uzatvárania malých defektov s dobrým výsledkom. 3 Implantácia ďalšej protézy technikou "valve to valve" je ďalšou popisovanou terapeutickou stratégiou.…”