Percutaneous closure of post-myocardial infarction ventricular septal defects: a single centre experience.
BACKGROUND
Ventricular septal defect (VSD) is a serious complication of myocardial infarction (MI), occurring in about 0.2% of cases. Untreated, mortality in high and early surgical repair is difficult because of friable necrotic tissue. Percutaneous closure may be an alternative treatment option in selected patients.


METHODS
We report our complete single centre experience of percutaneous post-MI VSD closure using the Amplatzer device. The VSD was closed under general anaesthesia with fluoroscopic and transoesophageal echocardiographic guidance. Clinical characteristics and outcomes are reported.


RESULTS
The five patients were aged from 66 to 76 years. Closure was attempted from 1 to 64 days post-MI. VSD closure was performed in two patients after surgical patch dehiscence (infero-apical and infero-basal VSDs). The procedure was successful in four patients, with failure to cross the interventricular septum in one. Thirty-day and 12-month survival was 3/5 (60%); no patient undergoing VSD closure early post-MI survived, whereas 3/3 in whom the procedure was undertaken >14 days post-MI survived, suggesting that it may be appropriate to delay attempts at percutaneous VSD closure after MI.


CONCLUSIONS
Percutaneous VSD closure post-MI appears to be a viable alternative to surgical repair, with favourable outcomes if it can be undertaken >14 days post-infarct.
Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand. JamilA@adhb.govt.nz
Jamil
J
Ahmed
Peter N
PN
Ruygrok
Nigel J
NJ
Wilson
Mark W I
MW
Webster
Sally
S
Greaves
Ivor
I
Gerber
D000368:Aged; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D017548:Echocardiography, Transesophageal; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D018658:Ventricular Septal Rupture / Q000209:etiology / Q000601:surgery*