Successful percutaneous treatment of recurrent post-infarction ventricular septal rupture using an Amplatzer duct occluder

Abstract

A 78-year-old woman was brought to our hospital for chest pain with shock status. An electrocardiogram showed ST elevation in the precordial leads. Echocardiography showed an anteroseptal wall motion abnormality with left-to-right shunt at the apex. Emergency coronary angiography revealed occlusion in the mid portion of the left anterior descending artery, and left ventriculography showed ventricular septal rupture (VSR). Despite successful emergency surgical VSR repair, the VSR recurred 10days after surgery, and the patient required intra-aortic balloon pumping and mechanical ventilation. Although reoperation for VSR closure was attempted 33days after admission, open heart surgery was not completed due to severe tissue adhesions from the prior cardiac surgery. The patient ultimately underwent transcatheter closure for VSR using an Amplatzer duct occluder 56days after hospital admission, and her hemodynamics markedly improved. She was transferred to a regional hospital for rehabilitation without oxygen therapy or intravenous treatments 81days after the percutaneous intervention. In conclusion, percutaneous device closure of post-infarction VSR may be an alternative treatment to surgical repair for inoperable cases.<Learning objective: Ventricular septal rupture (VSR) is a rare but frequently fatal complication of acute myocardial infarction and often requires early surgery. However, the recurrence rate of VSR after surgery is high, and reoperation is often difficult because of the critical nature of the patients’ condition. The present case report highlights the effectiveness of percutaneous closure of VSR using Amplatzer devices for seriously ill patients with a high risk of reoperation.>