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. CONCLUSION: 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.
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. CONCLUSION: 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.
Authors: Maria D Baldasare; Mark Polyakov; Glenn W Laub; Joseph T Costic; Daniel J McCormick; Sheldon Goldberg Journal: Tex Heart Inst J Date: 2014-12-01
Authors: Abdelfatah Abdelazim Elasfar; Muhammad Adil Soofi; Tarek Seifaw Kashour; Mohammed Koudieh; Mohammed Omar Galal Journal: Ann Saudi Med Date: 2014 Mar-Apr Impact factor: 1.526