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

Shabestari MM, Ghaderi F, Hamedanchi A - J Cardiovasc Thorac Res (2015)

Bottom Line: 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.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.

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Affiliation: Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

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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Mentions: In this patient, because of difficulties in the routine arterial approach, we decided to advance the A1 catheter from the femoral vein access to RV, then to LV via VSD. A 0.035 inches ×3 m Amplatz guidewire was advanced to RV crossing VSD into LV, ascending and then descending aorta for better support. The delivery sheath was then advanced from the venous side to the LV cavity over the wire and the dilator and the wire was carefully removed. A 20-mm Amplatzer PIMVSD device (AGA Medical) was used. The occluder device was then delivered to the LV. The device was extruded from the sheath until the LV disc was opened under echocardiographic guidance to ensure that the device did not open in the mitral chordal apparatus (Figure 2A). It was then withdrawn toward the interventricular septum. After further satisfactory echocardiographic evaluation of septal alignment, the RV disc was also deployed and the device was released from the delivery cable (Figure 2B).


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

Shabestari MM, Ghaderi F, Hamedanchi A - J Cardiovasc Thorac Res (2015)

© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492183&req=5

Mentions: In this patient, because of difficulties in the routine arterial approach, we decided to advance the A1 catheter from the femoral vein access to RV, then to LV via VSD. A 0.035 inches ×3 m Amplatz guidewire was advanced to RV crossing VSD into LV, ascending and then descending aorta for better support. The delivery sheath was then advanced from the venous side to the LV cavity over the wire and the dilator and the wire was carefully removed. A 20-mm Amplatzer PIMVSD device (AGA Medical) was used. The occluder device was then delivered to the LV. The device was extruded from the sheath until the LV disc was opened under echocardiographic guidance to ensure that the device did not open in the mitral chordal apparatus (Figure 2A). It was then withdrawn toward the interventricular septum. After further satisfactory echocardiographic evaluation of septal alignment, the RV disc was also deployed and the device was released from the delivery cable (Figure 2B).

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

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.

No MeSH data available.


Related in: MedlinePlus