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      Transcatheter Closure of Postinfarction Ventricular Septal Defect: A Case Report and Review of Literature

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          Abstract

          Ventricular septal rupture (VSR) is an uncommon but serious complication of acute myocardial infarction (MI), associated with a high mortality rate. Although early surgical treatment improves the prognosis, hospital mortality after emergency surgery remains high. Transcatheter closure of postmyocardial infarction ventricular septal defect (PIVSD) has emerged as a potential strategy in selected cases. Current interventional reports are mainly restricted to PIVSD closure in the chronic and subacute setting, which only give a short term result. Herein, we report a case of acute post-MI VSR that was successfully closed using an Amplatzer postinfarction muscular ventricular septal defect (PIMVSD) occluder device with good immediate and long-term outcomes. The patient had undergone urgent coronary artery bypass surgery 3 days earlier in the setting of acute MI.

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          Immediate primary transcatheter closure of postinfarction ventricular septal defects.

          Holger Thiele, Carl Kaulfersch, Ingo Daehnert … (2009)
          Immediate surgical repair of ventricular septal defect (VSD) complicating acute myocardial infarction is associated with high mortality. Percutaneous device closure appears to be safe and effective in patients treated for a residual shunt after initial surgical closure, as well as in patients with a chronic post-infarct VSD. Primary transcatheter VSD closure in the acute setting may also offer advantages over surgery. Between September 2003 and February 2008, 29 consecutive patients underwent primary transcatheter VSD closure. Clinical, procedural, and outcome data were collected. Patients were divided into those with and those without cardiogenic shock at presentation for risk stratification. The median follow-up time of surviving patients was 730 days. The median time between VSD occurrence and 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 major residual shunting, left ventricular rupture, and device embolization occurred in 41%. The overall 30-day survival rate was 35%. Mortality was higher for cardiogenic shock in comparison to non-shock patients (88 vs. 38%, P < 0.001). Interventional acute VSD closure is a promising technique that can be performed with a high procedural success rate and may offer an alternative to surgery. Despite the less invasive technique, mortality of postinfarction VSD remains high, particularly in patients with cardiogenic shock. Further developments in devices and delivery techniques are required.
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            Percutaneous closure of postinfarction ventricular septal defect: in-hospital outcomes and long-term follow-up of UK experience.

            Patrick A Calvert, James Cockburn, Dylan Wynne … (2014)
            Postinfarction ventricular septal defect carries a grim prognosis. Surgical repair offers reasonable outcomes in patients who survive a healing phase. Percutaneous device implantation represents a potentially attractive early alternative. Postinfarction ventricular septal defect closure was attempted in 53 patients from 11 centers (1997-2012; aged 72±11 years; 42% female). Nineteen percent had previous surgical closure. Myocardial infarction was anterior (66%) or inferior (34%). Time from myocardial infarction to closure procedure was 13 (first and third quartiles, 5-54) days. Devices were successfully implanted in 89% of patients. Major immediate complications included procedural death (3.8%) and emergency cardiac surgery (7.5%). Immediate shunt reduction was graded as complete (23%), partial (62%), or none (15%). Median length of stay after the procedure was 5.0 (2.0-9.0) days. Fifty-eight percent survived to discharge and were followed up for 395 (63-1522) days, during which time 4 additional patients died (7.5%). Factors associated with death after postinfarction ventricular septal defect closure included the following: age (hazard ratio [HR]=1.04; P=0.039), female sex (HR=2.33; P=0.043), New York Heart Association class IV (HR=4.42; P=0.002), cardiogenic shock (HR=3.75; P=0.003), creatinine (HR=1.007; P=0.003), defect size (HR=1.09; P=0.026), inotropes (HR=4.18; P=0.005), and absence of revascularization therapy for presenting myocardial infarction (HR=3.28; P=0.009). Prior surgical closure (HR=0.12; P=0.040) and immediate shunt reduction (HR=0.49; P=0.037) were associated with survival. Percutaneous closure of postinfarction ventricular septal defect is a reasonably effective treatment for these extremely high-risk patients. Mortality remains high, but patients who survive to discharge do well in the longer term. © 2014 American Heart Association, Inc.
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              Transcatheter closure of postinfarction ventricular septal defects using the new Amplatzer muscular VSD occluder: Results of a U.S. Registry.

              Ralf Holzer, David Balzer, Zahid Amin … (2004)
              The objective of this study was to assess the immediate and mid-term results of transcatheter closure of postinfarct muscular ventricular septal defects (VSDs) using the new Amplatzer postinfarct muscular VSD device (PIMVSD). Ventricular septal rupture occurs in 0.2% of myocardial infarcts and remains associated with very high morbidity and mortality. Data were prospectively collected for 18 patients who underwent attempted device closure of postinfarction VSDs between 2000 and 2003. Five patients underwent the closure in the acute phase (within 6 days from the infarct); the remaining patients underwent closure on day 14-95 after the diagnosis of the infarct. Outcome parameters included procedural success, evidence of residual shunts on echocardiography, and occurrence of procedure-related complications. The procedure was successful in deploying a device across the VSD in 16 of 18 patients. The 30-day mortality was 28%. Eleven patients are still alive and have been followed up for a median of 332 days. Two patients required a second procedure to close a residual VSD. At the most recent outpatient follow-up, the VSD was completely closed in two patients, six patients had a trivial or small residual shunt, and two patients had a moderate residual shunt. We conclude that percutaneous device closure of postinfarction VSDs using the Amplatzer PIMVSD occluder appears to be safe and effective. Further trials are required to assess long-term efficacy and compare the results with those of surgical closure. Copyright 2004 Wiley-Liss, Inc.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cardiovasc Thorac Res
                Journal ID (iso-abbrev): J Cardiovasc Thorac Res
                Journal ID (publisher-id): J Cardiovasc Thorac Res
                Journal ID (pmc): JCVTR
                Journal ID (publisher-id): TBZMED
                Title: Journal of Cardiovascular and Thoracic Research
                Publisher: Tabriz University of Medical Sciences
                ISSN (Print): 2008-5117
                ISSN (Electronic): 2008-6830
                Publication date (Print): 2015
                Volume: 7
                Issue: 2
                Pages: 75-77
                Affiliations
                1 Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
                2 Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
                3 Department of Cardiology and Intensive Care Medicine, University of Jena, Germany
                Author notes
                [* ] Corresponding author: Fereshteh Ghaderi, drghaderif@ 123456yahoo.com
                Article
                DOI: 10.15171/jcvtr.2015.17
                PMC ID: 4492183
                PubMed ID: 26191397
                SO-VID: c18f38a8-e7dd-47b1-a0ee-f2e6b95a9e29
                Copyright © © 2015 The Author(s)
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 April 2015
                Date accepted : 23 April 2015
                Page count
                Figures: 3, References: 13, Pages: 3
                Categories
                Subject: Case Report

                Keywords: myocardial infarction,ventricular septal rupture,interventional closure,amplatzer occluder device
                Data availability:
                Keywords: myocardial infarction, ventricular septal rupture, interventional closure, amplatzer occluder device

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