Plugging the Hole: Diagnosis and Management of Post–Myocardial Infarction Ventricular Septal Defect

Sharma, Esseim; Beale, Charles; Ehsan, Afshin; Sodha, Neel R.; Gordon, Paul; Apostolidou, Eirini

doi:10.1016/j.case.2020.04.001

Cited by 3 publications

(5 citation statements)

References 12 publications

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“…Delay between electrocardiographic documentation of STEMI and subsequent development of VSR ( Table 2 ). Twenty patients (13 male) belonged to this category [ [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] ]. Their mean age was 66.…”

Section: Resultsmentioning

confidence: 99%

“…Conversely, in the presence of severe hypotension, the systolic murmur of VSR “may be difficult to identify because turbulent flow across the defect is reduced” [ 61 ], and the same might also be true of the systolic murmur of PMR [ 62 ]. Clinicians should also be especially vigilant for “stepwise” evolution of VSR [ [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] ], whereby a patient with delayed presentation of STEMI initially presents without clinical or echocardiographic stigmata of VSR but subsequently experiences hypotension and/or increasing breathlessness signalling onset of VSR [ [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] ]. The onset of VSR, in such cases, is typically associated with new-onset pansystolic murmur.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A new dimension to the STEMI-related mortality risk seen in the COVID-19 pandemic era

Jolobe¹

2022

The American Journal of Emergency Medicine

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A new dimension to the STEMI-related mortality risk seen in the COVID-19 pandemic era

Jolobe¹

2022

The American Journal of Emergency Medicine

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“…Our previously CT data suggested that the 34 mm disc of the largest Amplatzer PI‐VSD device could only provide left‐sided coverage in 75% of the cases, 50% if measured by its 24 mm waist 5 . Alternatively, the Amplatzer atrial septal occluders can in theory confer wider coverage, up to 40 mm, and the experience has been reported in isolated case reports with good procedural success 8 . However, its clinical usage remains outside its design indication.…”

Section: Discussionmentioning

confidence: 99%

“…isolated case reports with good procedural success. 8 However, its clinical usage remains outside its design indication. It was shown in a major review series that Amplatzer Septal Occluders was reportedly the least preferred option in treating post-infarct VSR, as compared to other more robustly constructed alternative, such as the dedicated P.I muscular VSD occluders or even the regular muscular VSD occluder.…”

Section: The Techniquementioning

confidence: 99%

Transcatheter closure of large postinfarct ventricular septal defect: Initial results of prototype Occlutech® device including the first‐in‐human

Lee

Taliotis

Hamilton

et al. 2023

Cathet Cardio Intervent

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Background: Postinfarct ventricular septal rupture is a serious complication in delayed or failed reperfusion with a grim prognosis. The optimal timing and treatment option remain debatable in the absence of randomized controlled trials. Percutaneous device closure is a well-reported and less invasive treatment option but recent imaging studies indicate that majority of defects are too large to be adequately covered by the currently Conformite Europeenne and Food and Drug Administration approved occluder devices.Methods: Six patients presented with large and complex postinfarct ventricular septal ruptures, considered unsuitable for the Amplatzer post-infarct ventricular septal defect Occluder, so were treated using the prototype Occlutech ® 36 mm PI-VSD occluder, including the first-in-human use. Results:The prototype device was successfully deployed in all patients with satisfactory immediate results and shunt reduction. Three patients (50%) in cardiogenic shock did not survive beyond discharge, of which two were complicated by device dislodgement or embolization.Conclusions: Percutaneous closure of large postinfarct ventricular septal ruptures is possible using newer device with a wider coverage. Further device refinement is necessary to improve treatment outcomes.

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“…This occurs in the fairly typical location of a post-infarct apical ventricular septal defect (VSD). 4 The surrounding acutely infarcted tissue compounds the problem and even a moderate-sized VSD in this scenario can quickly extend to become a percutaneously unclosable defect as a stiff nitinol-based VSD device not infrequently fails to sit across the defect, pulls through enlarging the defect or even results in rupture of the LV. These scenarios usually result in failure to close the defect, partial defect closure, or death.…”

Section: Introductionmentioning

confidence: 99%

Post-myocardial infarction ventricular septal defect closure with Gore Cardioform atrial septal defect occluder to improve tissue interactions: case report

Hribernik

Bentham

2023

European Heart Journal - Case Reports

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Background Gore Cardioform Atrial Septal Defect Occluder (GCA) is composed of a platinum-filled nitinol wire frame covered with expanded polytetrafluoroethylene (ePTFE). This makes the device highly occlusive and resistant to residual shunt through the device, as well as conforming well to the surrounding anatomy. In defects with poor rims to hold a device for closure or where one of the ‘rims’ is the free wall of the left ventricle, such as in a post-infarct apical ventricular septal defect (VSD), successful closure with standard nitinol mesh devices is unlikely. Case summary We present occlusion of a post-myocardial infarction VSD with GCA in a critically ill patient at risk for closure failure and intravascular haemolysis with conventional nitinol mesh devices. The device conforms well to the anatomy even in the absence of apical interventricular septum. Discussion GCA can be used for intracardiac high velocity shunts in selected cases where conventional devices failed due to haemolysis or poor tissue interactions. With growing experience using GCA for closure of atrial septal defects, interventionists should acknowledge the potential advantages of ePTFE material and apply them to other lesions where these could be beneficial for the patients.

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Plugging the Hole: Diagnosis and Management of Post–Myocardial Infarction Ventricular Septal Defect

Cited by 3 publications

References 12 publications

A new dimension to the STEMI-related mortality risk seen in the COVID-19 pandemic era

A new dimension to the STEMI-related mortality risk seen in the COVID-19 pandemic era

Transcatheter closure of large postinfarct ventricular septal defect: Initial results of prototype Occlutech® device including the first‐in‐human

Post-myocardial infarction ventricular septal defect closure with Gore Cardioform atrial septal defect occluder to improve tissue interactions: case report

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