Ventricular septal rupture following nonsurgical septal reduction for hypertrophic cardiomyopathy: treatment with percutaneous closure.
An 82-year-old woman with severe symptomatic hypertrophic obstructive cardiomyopathy undergoes nonsurgical septal reduction, leading to immediate hemodynamic and functional improvement. Five weeks later, she presents with severe biventricular failure due to a large septal rupture with marked left-to-right shunting. The rupture is closed with an Amplatzer post-MI ventricular septal defect occluding device. Residual shunting through the device and a small residual shunt at its superior rim lead to severe hemolysis, which resolves spontaneously after 10 days of supportive therapy. A further self-limiting episode of hemolysis recurred 3 months later following a period of excessive anticoagulation.
Holy Spirit Northside Hospital, Brisbane, Queensland, Australia. conar@bigpond.net.au
Constantine N
CN
Aroney
Tiow H
TH
Goh
Lisa A
LA
Hourigan
William
W
Dyer
D000368:Aged; D000369:Aged, 80 and over; D002312:Cardiomyopathy, Hypertrophic / Q000628:therapy*; D005260:Female; D006801:Humans; D019736:Prostheses and Implants; D014463:Ultrasonography; D018658:Ventricular Septal Rupture / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy