Transcatheter closure of postinfarction ventricular septal defect using the Amplatzer atrial septal defect occluder

Percutaneous Closure of Post-infarction and Iatrogenic Ventricular Septal Ruptures Using Amplatzer Occluder®: A Systematic Review

Ventricular septal rupture (VSR) is a rare complication of myocardial infarction (MI), open heart surgery, and cardiac-based procedures, such as septal myectomy and valve replacement. VSR is associated with high mortality rates and the reported 30-day survival rate is less than 10% without any interventional therapy. Hence, prompt diagnosis and aggressive medical treatment with appropriate surgical intervention are necessary to improve survival. Immediate surgical intervention which is the standard treatment of VSR has a mortality rate of 19-60%. Due to persistent high mortality rate and challenging management of VSR, alternatives to surgical repair has been proposed; transcatheter approach as a new alternative method has been used for the closure of post-surgery residual defects or as a bridge to surgery and in some cases as a definitive therapy instead of surgical repair. Amplatzer Occluder® (AO), a type of transcatheter closure devices, is an approved method of repairing congenital atrial septal defects and it is being used as an alternative method of treatment in VSR. In this systemic review, we assessed the cases of VSR who underwent septal repair by using AO. The study shows that the total mortality rate of percutaneous VSR repair with AO is 20% which is comparable to 19-60% rate of death in patients who undergo surgery. While early intervention is necessary to prevent biventricular dysfunction, immediate surgical intervention on soft and friable tissue surrounding the infarction increases the risk of residual shunt and reoperation. However, this study reveals that the mortality rate of primary percutaneous VSR closure within 7 days of VSR detection was 37 % which is significantly lower than 60% in surgical repair in the same period. In conclusion, given that the prevalence of residual leak in both interventions are similar and close to 20%, percutaneous VSR closure with AO device could be superior to the surgical repair as a primary intervention in unstable or high-risk surgical patients.

Percutaneous repair of post-myocardial infarction ventricular septal defect: current approaches and future perspectives

Post-myocardial infarction ventricular septal defect is a devastating complication of ST-elevation myocardial infarction. Although surgical intervention is considered the gold standard for treatment, it carries high morbidity and mortality rates. We present 2 cases that illustrate the application of percutaneous closure of a post-myocardial infarction ventricular septal defect: the first in a patient who had undergone prior surgical closure and then developed a new shunt, and the second as a bridge to definitive surgery in a critically ill patient.

Acute Myocardial Infarction Complicated With Ventricular Septal Rupture: Report of Three Cases

We reported three cases of ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI), focusing on the causes, diagnosis, treatment and prevention. These three cases were diagnosed based on the findings of electrocardiogram, echocardiogram and blood myocardial markers, and were treated with conservative methods. These three cases were female, and all had history of hypertension and/or diabetes mellitus. In one case with age over 70, AMI was related to percutaneous coronary intervention of left anterior descending branch, and the stenosis of LAD resulted in AMI and subsequently VSR occurred, the patient's condition worsened rapidly and the patient died after. Only one of the three cases survived the VSR. We concluded that the prognosis of VSR complicating AMI is associated with the causes, age, sex and comorbidities, and the prevention is critically important.