MUSEUM OF HMH MULTIMODALITY IMAGING CENTER
Transcatheter Closure and Reintervention on an Expanding Post-Myocardial Infarction Ventricular Septal Rupture
Eric J. Bansal, Joshua L. McKay, and C. Huie Lin. Transcatheter Closure and Reintervention on an Expanding Post-Myocardial Infarction Ventricular Septal Rupture. Methodist DeBakey Cardiovascular Journal. January 2016, Vol. 12, No. 1, pp. 56-59.doi: https://doi.org/10.14797/mdcj-12-1-56
echocardiography , computed tomography , myocardial infarction , ventral septal rupture
A 74-year-old woman presented with an ST-elevation myocardial infarction (MI) and subsequently developed a post-MI apical ventricular septal rupture (VSR). Transesophageal echocardiogram (TEE) showed the defect to be 15 mm wide (Figure 1A). Due to hemodynamic instability, she underwent percutaneous closure of the VSR 5 days post-MI with an 18-mm AMPLATZER™ Muscular Ventricular Septal Defect (VSD) Occluder (St. Jude Medical, St. Paul, Minnesota) with no immediate evidence of residual shunt on TEE imaging (Figure 1B). Fourteen days after intervention, 64-slice cardiac computed tomography revealed that the inferior portion of the septum had torn away from the device due to ongoing tissue necrosis with evidence of left-to-right shunt through a recurrent VSR (Figure 2). Repeat percutaneous intervention was undertaken, and a 24-mm AMPLATZER Atrial Septal Defect Occluder (St. Jude Medical, St. Paul, Minnesota) was placed. Cine imaging (Figure 3) shows the AMPLATZER Atrial Septal Defect Occluder (labeled ASD) across the ventricular septum and adjacent to the originally placed AMPLATZER Muscular VSD Occluder (labeled mVSD). Final transthoracic echocardiography showed no significant residual shunt (Figure 4). LV: left ventricle; RV: right ventricle; ASD: AMPLATZER Atrial Septal Defect Occluder; mVSD: AMPLATZER Muscular Ventricular Septal Defect Occluder.