Device closure of post-myocardial infarction ventricular septal defect three weeks after coronary angioplasty

Abstract

Percutaneus device closure appears to be safe and effective in patients treated for a residual shunt after initial surgical closure, as well as after two to three weeks of index myocardial infarction. The index case presented with a ventricular septal defect on second of acute myocardial infarction thrombolysed with streptokinase. The general condition of the patient was fairly stable. Cardiac catheterization and coronary angiography showed significant left to right shunt and there was 90 % proximal stenosis of left anterior descending coronary artery. Other coronary arteries were normal. Angioplasty and stenting to the coronary artery lesion was done using drug eluting stent (DES) with very good angiographic result. Patient was discharged after four days in stable condtion. After 3 weeks his ventricular septal defect was closed percutaneusly using cardio -O-fix device with tiny residual shunt. The procedure was uneventful and of brief duration. He was discharged after 5 days of the post procedure in very stable condition with minimal residual shunt. A staged procedure is a better option if the condition of the patient allows strengthening ventricular septal defect border.

Keywords: Cardio-Fix-Occluder; myocardial infarction; ventricular septal defect.

Figure 1

12 lead electrocardiography shows persistent ST segment elevation in V2-V4 even after thrombolysis as an evidence of septal aneurysm

Figure 2

Echocardiography in apical four chamber view single and discrete muscular septal defect

Figure 3

Left ventricular angiogram in left anterior oblique view shows single discrete muscular VSD of size 10mm

Figure 4

Selective coronary hooking of right coronary artery reveals normal right coronary artery

Figure 5

Selective left coronary injection shows type B proximal significant stenosis in left anterior descending artery

Figure 6

Successful angioplasty and stenting of left anterior descending artery with very good angiographic result

Figure 7

Successful snaring of regular guide wire from left pulmonary artery from right internal jugular venous approach

Figure 8

Appropriate placement of Cardio-Fix septal occluder across ventricular septal defect with tiny residual shunt is evident from left ventricular angiogram in left anterior oblique view

Figure 9

Two dimensional color Doppler showing septal occluder exactly across the ventricular septal defect after four days of procedure