Transcatheter Closure of a Ventricular Septal Defect following Myectomy for Hypertrophic Obstructive Cardiomyopathy

Abstract

Post-operative ventricular septal defect (VSD) following septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM) is a rare complication which may warrant closure. Repeat early sternotomy for surgical closure of the VSD seems undesirable and transcatheter VSD closure may be a valid alternative. We report the case of successful closure of a 10-mm VSD following surgical therapy for HOCM using an Amplatzer Muscular VSD Occluder.

Closure of an iatrogenic ventricular septal defect using a hybrid approach and echocardiographic guidance

“…Review of literature found six reported cases of iatrogenic VSD after septal myectomy, which were treated with transcatheter techniques. [ 4 5 6 7 8 9 ] In all these cases, the occluder device was delivered antegradely via the femoral vein or internal jugular vein. Our case reported successful closure of an iatrogenic VSD through right atriotomy with a hybrid approach utilizing an atrial septal defect closure device.…”

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

“…The success in eliminating hemodynamically-significant shunts produce stabilization and improvement in the signs and symptoms for which the percutaneous VSD closure is undertaken. Some reports of patients who have undergone percutaneous VSD closure following septal myectomy have been published in literature, with reasonable results and limited complications 8)9). Percutaneous VSD closure with trans-aortic approach would be unsafe in patients with AVR, because a bulky VSD device might get entrapped in the artificial aortic valve.…”

Transcatheter closure of congenital and acquired septal defects

“…Transcatheter VSD closure, as opposed to surgical closure, can be considered in patients with muscular defects, especially if the VSD is remote from the tricuspid and aortic valves. Patients with residual defects after surgical closure or patients with iatrogenic defects after aortic valve replacement surgery or myomyectomy 6,54,55 are better served by a transcatheter closure. Closure of peri-membranous VSDs is possible with the Amplatzer peri-membranous VSD occluder; however, the risk of complete heart block is high, at 5-6%.…”