Percutaneous Closure of Post-myocardial Infarction Ventricular Septal Rupture

Ventricular septal rupture is a rare sequala of myocardial infarction typically appearing in the first week after the initial ischemic insult. Early revascularization strategies have reduced the incidence of post-myocardial infarction ventricular septal defect (PMI-VSD) to less than 1% of all myocardial infarctions however if they occur, the mortality remains high. Surgical closure of PMI-VSD carries a significant mortality risk and high chance of incomplete closure as the friable margins of the defect do not hold sutures well. Transcatheter closure of PMI-VSD was first reported in 1998. Results for primary transcatheter closure of PMI-VSD for large defects associated with shock remain poor. Better outcomes for later close of smaller defects or those who have residual VSD after attempted surgical closure fare better. In this section, we will describe a case of PMI-VSD and the strategies of transcatheter PMI-VSD closure.