Postinfarction Ventricular Septal Rupture: Identification of the Failure Mechanism of a Percutaneous Closure Procedure

Abstract

Ventricular septal rupture (VSR) is a rare but highly lethal (∼60%) mechanical complication of myocardial infarction (MI). Although surgical repair has been the gold standard to correct the structural anomaly, percutaneous closure of the defect may represent a valuable therapeutic alternative, with the advantage of immediate shunt reduction to prevent further hemodynamic deterioration in patients with prohibitive surgical risk. Nonetheless, catheter-based VSR closure has faced certain drawbacks that have hampered its application. We describe a clinical case of postinfarction VSR treated with a percutaneous closure device and discuss the procedure's failure mechanism. (Level of Difficulty: Intermediate.).

Keywords: ASD, atrial septal defect; CMR, cardiac magnetic resonance; CT, computed tomography; IABP, intra-aortic balloon pump; LAD, left anterior descending; MI, myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST-segment myocardial infarction; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography; VSD, ventricular septal defect; VSR, ventricular septal rupture; acute myocardial infarction; mechanical complication; percutaneous closure device; percutaneous septal defect closure; ventricular septal defect; ventricular septal rupture.