Turk Kardiyol Dern Ars. 2011; 39(6): 491-494 | DOI: 10.5543/tkda.2011.01459

Transcatheter device closure of a residual postmyocardial infarction ventricular septal defect

Yalim Yalcin¹, Cenap Zeybek², Ibrahim Ozgür Onsel³, Mehmet Salih Bilal^4
1Department of Pediatric Cardiology, Medicana International Hospital, Istanbul, Turkey
²Department of Pediatric Cardiology, Sisli Florence Nightingale Hospital, Istanbul, Turkey
³Department of Anesthesiology And Reanimation, Medicana International Hospital, Istanbul, Turkey
⁴Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey

Postmyocardial infarction ventricular septal defect (VSD) carries a high mortality and, even after successful surgery, residual defect is common. A 75-year-old woman was admitted with the diagnosis of hyperacute anterior myocardial infarction. Primary percutaneous intervention was performed by stenting of a totally obstructed segment in the proximal left anterior descending artery. The patient’s condition deteriorated on the second postprocedural day with a 3/6 pansystolic murmur at the mesocardium. Echocardiography revealed an apical anteroseptal VSD and moderate pulmonary hypertension. She underwent surgical VSD closure with a Gore-Tex patch and coronary artery bypass grafting to the left anterior descending and circumflex arteries. The patient’s condition continued to be unstable due to septicemia and hemodynamically significant residual VSD. After medical management of septicemia, the residual defect was successfully closed using a 10-mm Cardio-O-Fix septal occluder under fluoroscopic and transesophageal echocardiographic guidance. The clinical condition of the patient was then stabilized and there was no significant residual shunt on echocardiography on the third postprocedural day.

Keywords: Heart catheterization, heart septal defects, ventricular/etiology/complications/therapy, myocardial infarction/complications; ventricular septal rupture/etiology/therapy

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