Immediate primary transcatheter closure of postinfarction ventricular septal defects

Aims: Immediate surgical repair of ventricular septal defect (VSD)complicating acute myocardial infarction is associated withhigh mortality. Percutaneous device closure appears to be safeand effective in patients treated for a residual shunt afterinitial surgical closure, as well as in patients with a chronicpost-infarct VSD. Primary transcatheter VSD closure in the acutesetting may also offer advantages over surgery. Methods and results: Between September 2003 and February 2008, 29 consecutive patientsunderwent primary transcatheter VSD closure. Clinical, procedural,and outcome data were collected. Patients were divided intothose with and those without cardiogenic shock at presentationfor risk stratification. The median follow-up time of survivingpatients was 730 days. The median time between VSD occurrenceand closure was 1 day [interquartile range (IQR) 1–3]and the initial procedural success rate was 86%. The shunt (Qp:Qs)could be reduced from 3.3 (IQR 2.3–3.8) to 1.4 (IQR 1.2–1.7;P < 0.001). Procedure-related complications such as majorresidual shunting, left ventricular rupture, and device embolizationoccurred in 41%. The overall 30-day survival rate was 35%. Mortalitywas higher for cardiogenic shock in comparison to non-shockpatients (88 vs. 38%, P < 0.001). Conclusion: Interventional acute VSD closure is a promising technique thatcan be performed with a high procedural success rate and mayoffer an alternative to surgery. Despite the less invasive technique,mortality of postinfarction VSD remains high, particularly inpatients with cardiogenic shock. Further developments in devicesand delivery techniques are required.     

Percutaneous closure of perimembranous ventricular septal defects with Amplatzer occluders--a single centre experience

BACKGROUND: Perimembranous ventricular septal defect (VSD) is the most common congenital heart defect. Percutaneous transcatheter closure of VSD is one of the greatest challenges in interventional cardiology. AIM: Presentation of our experience in transcatheter closure of perimembranous VSD. METHODS: Eighteen patients were treated. Nine patients (group I) had VSD closed with implant Amplatzer Perimembranous VSD Occluder (PMVSDO) whereas the other nine had VSD closed with Muscular VSD Occluder (MVSDO). In the second group the presence of at least 4 mm rim from aortic valve was mandatory to undergo the procedure. Average patients age was 17.1 (3.2-40) years, defect diameter--4.7 (4-8) mm and Qp/Qs ratio--1.84 (1.5-4.6). Perimembranous interventricular septum aneurysm was noted in 5 cases. Only patients who had hemodynamically important defect (Qp/Qs ratio >1.5) were selected for interventional VSD closure. Patients with subarterial VSDs, pulmonary hypertension or/and aortic regurgitation were excluded. Ventricular septal defect closure was performed with standard techniques. RESULTS: Procedures were completed successfully in 16 of 18 patients. There was no early or late implant embolisation. After the procedure in every case complete closure or important reduction of the shunt was observed. In the group I there was a trend towards more frequent occurrence of rhythm disturbances (p=0,08), including two cases with severe arrhythmias occurring during VSD closure requiring abandoning of procedure. In other 2 cases (patients age 12 and 14 years) in the second week after PMVSDO placement complete atrio-ventricular block occurred. In one patient sinus rhythm was restored after steroid treatment whereas another patient required pacemaker implantation. In group II mild nonprogressive tricuspid regurgitation was noted in 3 patients. CONCLUSIONS: Percutaneous perimembranous VSD closure is an interesting alternative to surgical treatment. In selected cases closure of the defect with muscular VSD implant is effective and safe.     

房间隔缺损经导管封堵术对心率变异性的影响及意义

目的探讨房间隔缺损(ASD)经导管封堵术对心率变异性(HRV)的影响及意义。方法选择成功接受介入治疗的ASD患者118例为研究对象(ASD组),分别于术前1天及术后第4天记录24h动态心电图,由电脑自动分析并经心电专业人员校正,得出HRV的各项时域指标;另按术前心脏超声测得的肺循环血流量/体循环血流量(Qp/Qs)分为Ⅰ组(Qp/Qs<1.5)与Ⅱ组(Qp/Qs≥1.5),分析两亚组患者HRV,并行Qp/Qs与HRV的相关性分析。结果与对照组比较,ASD组封堵术前后24hRR间期标准差(SDNN)及24h内每5min节段RR间期均值标准差(SDANN)均显著降低(P<0.01或0.05);Ⅱ组降低更明显。ASD组封堵术后RR间期、SDNN及SDANN均较术前增加(P<0.05);Ⅱ组介入治疗术后的SDNN、ASDNN较Ⅰ组术后明显减小(P<0.05)。ASD患者术前SDNN及SDANN与Qp/Qs呈负相关(r值分别为-0.528、-0.644,P<0.01)。结论ASD封堵术后HRV水平明显恢复;Qp/Qs越大的ASD患者不仅术前HRV水平降低更显著,术后的恢复也越慢。     

Initial experience with the amplatzer membranous septal occluder in adults

Objectives: Most perimembranous ventricular septal defects (pmVSD) that are still patent in adult life are small, hemodynamically and clinically unimportant, and do not require any intervention. However, surgery in adulthood for those that need to be closed carries significant morbidity. A trans‐catheter technique for closing pmVSDs has been developed, and this paper describes our initial experience using the amplatzer membranous septal occluder (AMSO). Patients/methods: Twelve patients, 9 female and 3 male, median age 34.5 years (range: 21–67) underwent catheterization for attempted pmVSD closure. Ten of the defects were native and 2 were post‐operative residual defects. Transcatheter VSD closure was performed as previously described, under general anesthesia and with trans‐esophageal echocardiographic (TEE) monitoring. Patients had a moderate to large left to right shunt (mean Qp/Qs = 2.0±0.4) with mild left heart volume overload and near normal pulmonary pressure. All 10 native pmVSDs were closed successfully, 9 with AMSO and one with an Amplatzer muscular VSD occluder, after failure to implant the AMSO. There was one post procedural complication—self‐limiting retroperitoneal bleeding. Three patients had a residual leak. Attempted VSD closure in the 2 patients with post surgery residual shunt was unsuccessful. Conclusion: We conclude that transcatheter mVSD closure with the AMSO is an efficient and safe alternative to surgery in carefully selected adult patients with native pmVSDs.     

Transcatheter closure of congenital and acquired muscular ventricular septal defects using the Amplatzer device

Surgical closure of congenital or post-myocardial infarction (MI) muscular ventricular septal defect (MVSD) is associated with significant mortality and morbidity; therefore, both surgeons and cardiologists would welcome a safe non-surgical approach. The aim of this study is to report the combined experience of 2 cardiac centers in the transcatheter occlusion of both congenital and acquired MVSDs using the Amplatzer MVSD occluder device (AGA Medical Corporation, Golden Valley, Minnesota). Thirty-two patients underwent attempted transcatheter closure of an MVSD. Nineteen of these patients had congenital unoperated MVSD, twelve had post-MI MVSD and 1 patient had an acquired VSD post-surgical repair of hypertrophic cardiomyopathy. The median age of patients was 11.5 years (range, 0.1 86.0 years) and median weight was 34.5 kg (3.4 123.0 kg). All patients had significant shunt documented by echocardiography with a median Qp/Qs ratio of 1.7 (range, 1.0 5.3). The VSD location was mid-muscular in 14 patients, posterior in 10, apical in 5 and anterior in 3. The systolic pulmonary artery pressure ranged from 10 85 mmHg (median, 34.5 mmHg). The device was implanted successfully in 30 patients. The device size ranged from 6 26 mm (2 of these were ASD devices). There was immediate complete closure of the defect in 15 patients and 14 patients had residual shunt (foaming through the device). The median fluoroscopy time was 56.7 minutes (range, 11.7 146.0 minutes). Complications included: tamponade in 1 patient resulting in death; device malposition in 1 patient requiring surgical removal; severe hemolysis in 2 patients; and transient junctional rhythm in 1 patient. Among the 30 patients with successful implantation, three died in the hospital and 2 died later. On follow-up evaluation, there were no episodes of endocarditis, thromboembolism, hemolysis or wire disruption. We conclude that the Amplatzer MVSD occluder is a safe and effective device for closure of MVSDs up to 14 mm in diameter. Further clinical trials with this device are underway.     

Transcatheter closure of a complex postmyocardial infarction ventricular septal defect after surgical patch dehiscence

Ventricular septal defect (VSD) complicating acute myocardial infarction is a rare but serious event carrying a high mortality. Residual shunting after emergency surgical repair is common, adversely affects prognosis and can necessitate reoperation. We describe the successful transcatheter VSD closure with the Amplatzer occluder in a 75-year old man after earlier emergency surgical repair of a VSD complicating an acute myocardial infarction. The technique and positioning of the device in a tortuous infero-apical VSD are described.     

Combined catheter ventricular septal defect closure and multivessel coronary stenting to treat postmyocardial infarction ventricular septal defect and triple-vessel coronary artery disease: a case report.

Ventricular septal defect following acute myocardial infarction is a rare but life-threatening complication. Early surgical closure improves survival but carries a considerable risk. Percutaneous transcatheter closure is an alternative but experience to date is limited. We report a case of successful transcatheter closure of postmyocardial infarction ventricular septal defect (VSD) in a 55-year-old male with the Amplatzer muscular VSD occluder device and complete percutaneous revascularization with successful multivessel coronary stenting for three-vessel disease as a staged procedure. The technique and its potential use as an alternative to surgical approach for treatment of acute myocardial infarction and its complication (VSD) are discussed.     

Percutaneous closure of postoperative ventricular septal defects with the Amplatzer device.

The objective of this study was to look at the procedure, the results, and the follow-up of patients who underwent percutaneous closure of a residual ventricular septal defect (VSD) following a surgical closure using the Amplatzer VSD device. Four patients had an original diagnosis of tetralogy of Fallot, two patients had a patch leak following a surgical repair of a VSD, and three patients had a VSD not repaired at the time of surgery. All patients fulfilled the currently accepted surgical criterion for reoperation (Qp/Qs>1.5). The mean Qp/Qs was 1.8+/-0.3 (1.5-2.3). Four patients underwent VSD closure using an Amplatzer perimembranous VSD device and in five patients an Amplatzer muscular VSD device was implanted. We performed percutaneous closure in nine patients. The size of the residual shunt ranged from 6 to 14 mm and the size of device used ranged from 8 to 16 mm. The arteriovenous loop needed to be recreated in two patients because of failure to advance the delivery sheath. There was complete closure of the defect in six cases, and a small residual shunt remained in three cases. Percutaneous closure of postoperative VSDs appears to be an effective way to resolve a hemodynamically significant residual shunt. There were no difficulties encountered with implantation of the devices. These promising short-term results need reinforcement with additional long-term data.     

Initial experience with the Amplatzer membranous septal occluder in adults

OBJECTIVES: Most perimembranous ventricular septal defects (pmVSD) that are still patent in adult life are small, hemodynamically and clinically unimportant, and do not require any intervention. However, surgery in adulthood for those that need to be closed carries significant morbidity. A trans-catheter technique for closing pmVSDs has been developed, and this paper describes our initial experience using the Amplatzer membranous septal occluder (AMSO). PATIENTS/METHODS: Twelve patients, 9 female and 3 male, median age 34.5 years (range: 21-67) underwent catheterization for attempted pmVSD closure. Ten of the defects were native and 2 were post-operative residual defects. Transcatheter VSD closure was performed as previously described, under general anesthesia and with trans-esophageal echocardiographic (TEE) monitoring. Patients had a moderate to large left to right shunt (mean Qp/Qs = 2.0+/-0.4) with mild left heart volume overload and near normal pulmonary pressure. All 10 native pmVSDs were closed successfully, 9 with AMSO and one with an Amplatzer muscular VSD occluder, after failure to implant the AMSO. There was one post procedural complication--self-limiting retroperitoneal bleeding. Three patients had a residual leak. Attempted VSD closure in the 2 patients with post surgery residual shunt was unsuccessful. CONCLUSION: We conclude that transcatheter mVSD closure with the AMSO is an efficient and safe alternative to surgery in carefully selected adult patients with native pmVSDs.     

Pulmonary Atresia with Ventricular Septal Defect and Multifocal Pulmonary Blood Supply: Does an Intensive Interventional Approach Improve the Outcome?

Introduction. Pulmonary atresia with ventricular septal defect (VSD) continues to be associated with significant morbidity and mortality, with significant institutional variation in therapeutic strategies. This study reports a single center experience utilizing an intensive transcatheter approach to promote pulmonary vascular growth. Methods. A retrospective analysis of 20 patients undergoing surgical and transcatheter treatment for pulmonary atresia with VSD between 2002 and 2010. Results. The median age at initial surgical palliation was 6.3 months (8 days to 2.5 years). Eleven patients (group 1) underwent initial surgical palliation without VSD closure and nine patients (group 2) underwent an initial complete repair with fenestrated or complete VSD closure. Group 1 had a smaller Nakata index (54 mm²/m² vs. 134 mm²/m², P= .04) and a smaller absolute native pulmonary artery diameter (2.7 mm vs. 4.5 mm, P= .01) than group 2. Intraoperative angiography was performed in 10 cases to evaluate if early transcatheter intervention was warranted. The median follow‐up during the study period was 2.3 years (1.6 months to 8.3 years). Of the 16 patients who survived the initial early postoperative period, 15 patients (94%) went on to receive surgical (n = 11) and/or interventional (n = 25) catheterization procedures. There was improvement in the mean Nakata index from the initial presurgical evaluation to the most recent catheterization data (38.4 mm²/m² vs. 169.7 mm²/m², P≤ .05). To date, two of 11 (18%) patients in group 1 ultimately underwent surgical VSD closure. Overall mortality was six of 20 (30%) with four deaths in group 1 and two deaths in group 2. There were no procedural deaths. Conclusions. Combining surgical unifocalization procedures with subsequent early and intensive catheter‐based pulmonary artery rehabilitation may improve vascular growth, ultimately rendering many patients suitable for fenestrated VSD closure. Risk stratification, including intraoperative exit angiography, is essential to determine the need for early transcatheter interventions.     

Outcomes of Transcatheter Closure in Outlet-Type Ventricular Septal Defect after 1 Year

Background: Ventricular septal defect (VSD) is the most common congenital heart disease. Transcatheter VSD closure is an effective treatment for patients with muscular and perimembranous VSD. However, there is a limit data for outlet VSD, especially impact to the aortic valve leaflet after transcatheter closure. This study aims to assess the outcomes of transcatheter closure of the outlet-type ventricular septal defect (OVSD) after 1 postoperative year. Methods: A retrospective study was performed including 50 patients who underwent transcatheter (n = 25) and surgical (n = 25) OVSD closure during the exact time frame at two medical centres. Results: The median age and body weight of patients in the transcatheter group were significantly higher than those of patients in the surgical group (7.0 vs. 2.8 years; 27.0 vs. 11.4 kg; p < 0.01). The defect size in the surgical group was significantly larger than that in the transcatheter group (5.0 vs. 3.0 mm; p < 0.01). All OVSD patients have successful transcatheter closure (100%) as effective as surgical closure. Less than small residual shunt was present 20% and 8% immediately after the procedure in the transcatheter and surgical groups (p = 0.50), which decreased to 12% and 4% at the 1-year follow-up (p = 0.61), respectively. No incidence of complete atrioventricular block and other complications was observed in both groups, and no significant differences were noted in the new onset or worsening of the aortic regurgitation in both groups (p = 1.0). Conclusions: Transcatheter treatment could be effectively and safely achieved for OVSD closure at 1-year follow-up.     

Percutaneous closure of postoperative and post-traumatic ventricular septal defects

Although uncommon, significant postoperative residual leaks may occur after repair of any type of ventricular septal defect (VSD). Post-traumatic VSDs are even rarer, but can be occasionally seen after penetrating or blunt chest trauma. When these defects are associated with significant left-to-right shunting (Qp/Qs > 1.5) with persistent left ventricular volume overload, intervention is generally recommended. Surgical treatment requires cardiopulmonary bypass with its attendant morbidity, increased hospital stay and possible long-term neurological impairment. With the evolving experience of transcatheter closure of postinfarction and native perimembranous and muscular VSDs, this less invasive method became an attractive alternative to manage these postoperative and post-traumatic defects. In this paper, we report on 3 patients with such residual leaks after repair of a perimembranous defect, which was closed using a perimembranous Amplatzer VSD occluded after a failed attempt using a NitOcclud coil. One patient had a mid-muscular post-traumatic defect after a penetrating chest wound, and another patient had a residual leak after a patch repair of a large post-traumatic muscular defect with outlet extension after a blunt chest trauma. Both defects were closed using muscular Amplatzer VSD occluders. All procedures were uncomplicated, and there were no technical difficulties with device implantation. All 3 patients' defects were completely closed at follow up. Percutaneous closure of traumatic and residual postoperative VSDs appears to be safe and effective. A larger number of patients and longer follow-up period are needed before the widespread use of this technique can be recommended.     

Transesophageal echo to help percutaneous closure of ventricular septal defect post acute myocardial infarction

Ventricular septal defect after acute myocardial infarction (AMI) is a complication associated with poor outcome in the absence of intervention. We report a case of successful TEE guided transcatheter closure of a post myocardial infarction (MI) ventricular septal defect (VSD) with an Amplatzer occluder in a 79 years old male with cardiogenic shock.     

Author Index

Ventricular septal defect after acute myocardial infarction (AMI) is a complication associated with poor outcome in the absence of intervention. We report a case of successful TEE guided transcatheter closure of a post myocardial infarction (MI) ventricular septal defect (VSD) with an Amplatzer occluder in a 79 years old male with cardiogenic shock.     

Assessment of hemodynamic status in the intensive care unit immediately after closure of ventricular septal defect

Hemodynamic values measured 12 to 24 hours postoperatively in the intensive care unit (ICU) were compared with those measured at a later cardiac catheterization in 68 patients after closure of ventricular septal defect (VSD). A pulmonary arterial (PA) saturation of more than 80% or a pulmonary to systemic blood flow ratio (Qp:Qs) greater than 1.5 in the ICU were sensitive indicators for identifying patients at risk of having a hemodynamically significant residual left-to-right shunt (Qp:Qs greater than 1.5) at catheterization. Measurement of PA pressure in the ICU was a useful predictor of PA pressure at catheterization. In the absence of factors known to alter PA pressure, measurement of PA pressure in the ICU overestimates what it will be at a subsequent cardiac catheterization. Early assessment of hemodynamics after closure of VSD is useful in identifying patients at risk of having hemodynamically significant residual VSD and those who may have persistent PA hypertension.     

Changes in Reverse Cardiac Remodeling after Percutaneous Atrial Septal Defect Closure in Children and Adults

Background: The influence of the timing of transcatheter atrial septal defect (ASD) closure on ventricular remodeling at 6 months after ASD closure is unclear. This study investigated changes in cardiac remodeling after transcatheter closure of large ASDs according to patient age at the time of the procedure. Methods: In this study, 41 children and 43 adults underwent percutaneous closure of a large ASD. Cardiac remodeling was assessed by two-dimensional echocardiography and electrocardiography before and at 6 months after ASD closure. Results: The age of the children and adults were 2.8 ± 3.1 and 50.0 ± 15.6 years, respectively. The Qp/Qs ratio of all patients was 2.24 ± 0.67. The right atrial (RA) maximal dimension and right ventricular (RV) transverse diameter were significantly decreased and the left ventricular (LV) dimension was significantly increased at 6 months after ASD closure. However, the difference in RA and RV dimension changes between the groups was not statistically significant. The difference in left atrial (LA) dimension changes between the groups was also not statistically significant, but the LV dimension significantly increased in children compared with that in adults (P = 0.018). The RV/LV ratio was decreased after ASD closure, and a significant difference was found in the RV/LV ratio changes between the groups. In ECG, the PR interval was significantly more decreased in adults than in children (P = 0.003). Conclusions: In conclusion, the LV diameter was significantly more increased in children than in adults at 6 months after percutaneous ASD closure. Thus, cardiac remodeling after percutaneous ASD closure varies in children and adults.     

Noninvasive estimation of left ventricular end-diastolic pressure using tissue Doppler imaging combined with pulsed-wave Doppler echocardiography in patients with ventricular septal defects: a comparison with the plasma levels of the B-type natriuretic Peptide

BACKGROUND: There are limited data regarding whether the ratio of the peak transmitral flow velocity during early diastole (E) to the peak mitral annular velocity during early diastole (Ea) obtained by tissue Doppler imaging (TDI) and the plasma levels of the B-type natriuretic peptide (BNP) are useful for evaluating the left ventricular end-diastolic pressure (LVEDP) in children with ventricular septal defects (VSD). We investigated the validity of noninvasive estimation of the LVEDP in VSD infants. METHODS: We studied 48 patients (mean age, 9 +/- 6 months). Using pulsed-wave Doppler echocardiography and TDI, E and Ea were measured to calculate the E/Ea ratio. The LVEDP and the ratio of pulmonary to systemic blood flow (Qp/Qs) were determined invasively. RESULTS: There were significant positive correlations between E and both the LVEDP value and the Qp/Qs ratio. In contrast, Ea showed significant negative correlations with the LVEDP value and Qp/Qs ratio. The E/Ea ratio correlated significantly with the LVEDP value and Qp/Qs ratio. The plasma BNP levels correlated significantly with the Qp/Qs ratio, although they did not show a significant correlation with the LVEDP. An E/Ea ratio of >9.8 indicated patients with a LVEDP of >10 mmHg with a sensitivity of 92% and specificity of 80%. CONCLUSION: TDI combined with pulsed-wave Doppler echocardiography predicted the LVEDP of VSD infants, whereas the plasma BNP value did not have a significant association with the LVEDP.     

Atrial septal defect in adults: the influence of age and haemodynamic parameters on the results of surgical repair

INTRODUCTION: Indications for closure of atrial septal defect (ASD) are well established in children but still unclear in adult patients. There is also a discrepancy regarding the natural history of the defect and benefits of ASD closure and long-term prognosis. AIM: The aim of the study was to evaluate the outcome of surgical closure of atrial septal defect (ASD) with respect to age and selected haemodynamic parameters. METHODS: The study involved 52 patients with ASD, aged 38.6+/-15 years. All patients had a clinical examination, echocardiography, Holter ECG monitoring and cardiopulmonary exercise test (CPX) prior to and at least one year after the surgery. The results were analysed for the entire group of patients and then for the following subgroups of pts.: aged <40 and ?40 years; with right ventricular systolic blood pressure (RVSP) < or =30 and >30 mmHg; and with shunt volume ratio (Qp/Qs) <2.5 and > or =2.5. RESULTS: After repair of ASD, a significant improvement of the clinical status, as defined by NYHA class, was observed. At the same time, a constant or even increased incidence of arrhythmias was found. Repair of the defect resulted in a significant reduction of the right ventricular diameters in all studied subgroups. Among all evaluated parameters, only age at time of the operation was significantly associated with right ventricular diameter after surgery (b=0.598; p <0.001). Exercise capacity was found to have significantly increased after surgery, regardless of age, RVSP and Qp/Qs, but it remained significantly reduced in patients with pulmonary arterial hypertension compared to subjects with normal RVSP before ASD repair. A significant correlation was shown between peak oxygen consumption and RVSP both before (r=-0.68; p <0.001) and after (r=-0.38; p=0.01) surgery. CONCLUSIONS: Patients benefit from surgical closure of ASD regardless of age and previous RVSP and Qp/Qs. Age at the time of surgery and pulmonary arterial pressure determine long-term results and improvement of echocardiographic and ETT parameters.     

Echocardiographic estimation of a left-to-right shunt in isolated ventricular septal defects

35 infants and children with isolated ventricular septal defects (VSDs) had echocardiographic examination within 24 h of cardiac catheterization. Left atrial to aortic root (LA : Ao) ratio, left atrial internal dimension/meter square body surface area (LAID/m2) and left ventricular internal dimension in diastole/meter square body surface area (LVIDd/m2) were compared with the cardiac catheterization determined pulmonary-to-systemic flow (Qp : Qs) ratio. 35 children with normal cardiovascular findings served as controls. The LA : Ao ratio in the VSD group (1.38 +/- 0.13) was significantly higher than in the control group (1.01 +/- 0.05) (P less than 0.01). Similarly the LAID/m2 and LVIDd/m2 were significantly higher in the VSD group than in the control group (P less than 0.01). Additionally, echographic dimensions were increased in proportion to the elevation of Qp : Qs (r = 0.71--0.73). LA : Ao ratios higher than 1.4 : 1 were generally associated with Qp : Qs ratios greater than 2 : 1. All patients with Qp : Qs greater than 2 : 1 had LA : Ao ratios of 1.4 or higher. This study suggested that echocardiography is a useful noninvasive technique in estimating the Qp : Qs in patients with isolated VSDs, and may serve as an additional clinical parameter in the assessment of patients with VSDs.     

Post-Myocardial Infarction Ventricular Septal Defect: A Comprehensive Review

Post-myocardial infarction (MI) ventricular septal defect (VSD) is a rare but potentially catastrophic mechanical complication that occurs in <1% of patients following a myocardial infarction and it is associated with a high morbidity and mortality despite improvements in medical and surgical therapies. Post-MI VSD is a medical emergency and outcome is very poor in medically treated patients. Treatment of choice remains surgical closure of defect and transcatheter defect closure less so. We performed a comprehensive review of the clinical presentation and management options of post-MI VSD.