Management of post-myocardial infarction ventricular septal rupture.

Ventricular septal rupture (VSR) post acute myocardial infarction is associated with a high mortality rate if not treated. Early surgical repair is recommended regardless of haemodynamic status. We review the role of transcatheter device closure for VSR, which has emerged as an alternative to surgery. The procedure itself has a high technical success rate with a relatively low complication rate; however, it is associated with high in-hospital mortality rates when performed in the early phase. Results post transcatheter closure are best in the subacute phase post MI (in part reflective of a selection bias), or post surgical repair with a patch leak. Transcatheter closure can otherwise be considered in patients who are not surgical candidates, who generally have haemodynamically tolerable defects, and who survive a period of watchful waiting. In general, a hybrid strategy of early surgical closure with transcatheter device closure of a patch leak (if it occurs) is a favoured strategy. Long-term outcomes appear good in patients with or without prior surgery who survive to hospital discharge.