Residual postmyocardial infarction ventricular septal defect repair through right atrium with right thoracotomy on beating heart technique

Postinfarction ventricular septal rupture: Transcatheter intervention or surgical repair?

Postinfarction ventricular septal rupture is an infrequent but potentially fatal complication of acute myocardial infarction. The 30-day mortality rate with the transcatheter approach when performed in the acute phase (<2 weeks) was 25.3% compared to 50% when surgery is performed in the acute phase (within 3 weeks). There is no correlation between defect size and mortality. New York Heart Association class IV and time to ventricular septal defect closure are risk predictors for transcatheter closure for a 30-day mortality rate of 31.5%.

Transcatheter closure of post-myocardial infarction ventricular defect: Where are we?

Since 1988, TCC of PMIVSD became an alternative treatment for anatomically suitable patients with high risk of surgical closure. TCC is less invasive but the optimal timing and technique have not developed much in the last four decades. The dismal prognosis at the contemporary sight should not be discouraged. The rapid innovation in TAVI is an example. The learning curve slopes down to the line of inertia in inaction. Some innovations have slept for centuries but their potential needs to be celebrated. The published experience of TCC of PMIVSD across the globe is limited as they are based on consensus. The experience related to clinical practice has heterogeneous topography around the globe because of the morbid pathology. The increasing number of onsite cardiothoracic wings, better imaging tools, LVADS, and ECMO, along with improvement in well matching hardware to the pathology of PMIVSD, build incremental confidence. The improved outcomes believes in the enthusiasm of closing the PMIVSD using either surgical or TCC approach and is recommended.

Management of recurrent leaks following postinfarction ventricular septal defect repairs

Ventricular septal rupture (VSR) complicates acute myocardial infarction (AMI) in less than 0.2% of cases and is usually surgically managed by endocardial patch repair with infarct exclusion. Although successful in 80% of cases, failure of patch repair (often because of patch dehiscence) results in attempts at percutaneous closure as reoperative mortality can be as high as 40%. We describe a case of an AMI in a 63-year-old male with resultant VSR that required repeat surgical patch repair secondary to recurrent leak. We discuss the management of recurrent leaks and surgical techniques aimed at decreasing residual defects.