APerventricular device closure of post-myocardial infarction ventricular septal defect: Can it combine best of both worlds!

Alok Ranjan,Arool Shukla,Kalpesh Malik,Kanaiyalal Patel,Manik Chopra

doi:10.5348/ijcri-201647-cr-10635

Abstract

Introduction: Post-myocardial infarction ventricular septal defect (VsD) is a rare but dreadful complication of acute myocardial infarction. current management of this complication has high morbidity and mortality rates. A hybrid approach (perventricular device closure) to high risk congenital muscular VsD has shown promising results. We report first case of a perventricular device closure of post infarct VsD by Amplatzer post-infarct muscular VsD device. case report: A 52-year-old male was referred to us for rapidly progressive dyspnea. He had anterior wall myocardial infarction, complicated by post-infarct VsD. His coronary angiography revealed 90% lesion in left anterior descending (LAD) artery. Perventricular device closure of VsD (Amplatzer post-infarct muscular VsD device) and graft to the LAD were performed using a beating heart technique. His postoperative stay was complicated by an enlarged secondary

Highlights

Post-myocardial infarction ventricular septal defect (VSD) is a rare but dreadful complication of acute myocardial infarction
We report first case of a perventricular device closure of post infarct VSD by Amplatzer post-infarct muscular VSD device
We report a case of perventricular closure of post-myocardial infarction VSDs (PI-VSD) with an Amplatzer post-infarct muscular VSD device

Summary

INTRODUCTION

Acquired ventricular septal defect (VSD) is one of the three major mechanical complications of acute myocardial infarction (AMI), the other two being acute mitral regurgitation and rupture of the ventricular free wall. Managed patients with post-myocardial infarction VSDs (PI-VSD) have 30-day mortality rates as high as 94% [1]. We report a case of perventricular closure of PI-VSD with an Amplatzer post-infarct muscular VSD device. A 16-mm Amplatzer post-infarction muscular VSD device (St. Jude Medical, Inc., USA) was selected and was advanced through the sheath. There was no residual shunt across the device but shunt across the additional VSD was present He had hepatic and renal dysfunction which required intensive treatment and he was shifted to ward on 5th postoperative day. The patient remains in NYHA class II symptoms with LVEF 30% He has a small residual shunt and has two devices across the interventricular septum (Figure 3C–D)

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DISCUSSION

CONCLUSION