Post-Myocardial Infarction Ventricular Septal Defect Repair

Ischemic or post-myocardial infarction (MI) ventricular septal defects (VSD) are a rare but potentially catastrophic mechanical complication that occurs in less than 1% of patients following a MI. It is associated with a high morbidity and mortality despite improvements in medical and surgical therapies. Post-MI VSD is often a medical emergency and the outcome is very poor in medically treated patients. The treatment of choice remains surgical closure of the defect. However, trans-catheter defect closure has been used with success in selected instances.

We present a case of a 67 year old man who was admitted to hospital 4 days after an episode of severe chest pain. His coronary angiogram showed occlusion of the distal right coronary artery consistent with a delayed presentation of an inferior acute MI. He was then found to have loud murmur. Echocardiography showed a 17mm defect in the inferior-basal ventricular septum, establishing a diagnosis of post-MI VSD. He remained stable on medical treatment. Six weeks later we performed surgical repair of the VSD. This video shows the technique we used in this case. The patient went on to make a good recovery.

 Video footage captured using the Parallel Medical Clinical Camera (https://www.parallel-medical.com). 

 Music: Max Bruch - Kol Nidrei, Ireland National Symphony Orchestra, Maria Kliegel, cello, Gerhard Markson, conductor. Naxos 8.550519