Alessia Faccini1, Gianfranco Butera2,3. 1. Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy. 2. Department of Pediatric Cardiology and Adults with Congenital Heart Disease, Evelina Children's Hospital- St Thomas Hospital, 249 Westminster Bridge Road, London, SE1 7EH, UK. gianfrancobutera@libero.it. 3. King's College London, 57 Waterloo Road, London, SE1 8WA, UK. gianfrancobutera@libero.it.
Abstract
PURPOSE OF REVIEW: This review aims to delineate the actual role of percutaneous intervention in the closure of post-myocardial infarction ventricular septal defect (post-MI VSD) and to briefly summarize the main steps of this procedure. RECENT FINDINGS: Most of the published studies report experiences using Amplatzer devices for post-MI VSD closure. In the acute phase, morbidity and mortality are quite high up to 70%, with a mean success rate of 90%, with 95% confidence intervals from 60 to 100%, and a 30-day mortality of 40%, with 95% confidence intervals from 0 to 55%. In the chronic phase, that is 14 days after myocardial infarction, results are very encouraging, with lower morbidity and mortality (23% at 30 days) and a higher rate of complete closure. A multimodality imaging approach has been proposed in order to increase the success rate of this procedure. Percutaneous closure is a safe and effective procedure in highly specialized centers and an appropriate patient selection is of paramount importance to the success of the procedure. Device closure of post-MI VSD can be considered a true alternative to the standard surgical approach. However, many problems still exist for percutaneous post-MI VSD treatment.
PURPOSE OF REVIEW: This review aims to delineate the actual role of percutaneous intervention in the closure of post-myocardial infarction ventricular septal defect (post-MI VSD) and to briefly summarize the main steps of this procedure. RECENT FINDINGS: Most of the published studies report experiences using Amplatzer devices for post-MI VSD closure. In the acute phase, morbidity and mortality are quite high up to 70%, with a mean success rate of 90%, with 95% confidence intervals from 60 to 100%, and a 30-day mortality of 40%, with 95% confidence intervals from 0 to 55%. In the chronic phase, that is 14 days after myocardial infarction, results are very encouraging, with lower morbidity and mortality (23% at 30 days) and a higher rate of complete closure. A multimodality imaging approach has been proposed in order to increase the success rate of this procedure. Percutaneous closure is a safe and effective procedure in highly specialized centers and an appropriate patient selection is of paramount importance to the success of the procedure. Device closure of post-MI VSD can be considered a true alternative to the standard surgical approach. However, many problems still exist for percutaneous post-MI VSD treatment.