Transcatheter management of ventricular septal rupture after myocardial infarction.

Despite improvements in surgical management of ventricular septal rupture (VSR) after myocardial infarction (MI), perioperative risk may be excessive for particular patients. Our experience with transcatheter closure of congenital ventricular septal defects led to our transcatheter attempts to close VSR after MI in patients without prior surgical repair who were thought to have prohibitive surgical risk (7), or similarly ill patients who had residual shunting after attempted surgical VSR closure (11). Of the 11 patients with postoperative residual patch-margin defects, survival (median 54 months) has not been limited by procedural success in any. Of the 7 patients without prior surgical repair, survival past hospitalization or to the present occurred in 3 patients, all of whom presented months after initial VSR. All survivors are in NYHA class II. Our experience suggests that optimal management of patients with post MI-VSR requires surgical-medical collaboration that extends surgical success to highest risk patients via catheter-based therapeutics.