A Percutaneous Solution for Treatment of a Large, Ischaemic Ventricular Septal Defect Presenting with Cardiogenic Shock

Abstract

Introduction: A 73-year-old man presented to a peripheral hospital with anginal chest pain and anterolateral ST elevation on electrocardiogram and underwent percutaneous intervention to an occluded left anterior descending artery. He had a history of medically managed proximal right coronary artery occlusion. Post–percutaneous intervention auscultation revealed a new pan-systolic murmur at the left sternal edge. Transthoracic echocardiography (TTE) revealed severe, regional left ventricular systolic dysfunction (ejection fraction 32%) and a 0.9-cm ventricular septal defect (VSD). He subsequently developed ventricular arrhythmias and acute renal failure. Repeat TTE showed increasing VSD size (2.0 cm), left–right shunting, and a 38-mmHg pressure gradient.