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

Abstract

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.