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. 2014 Jan;44(1):45-8.
doi: 10.4070/kcj.2014.44.1.45. Epub 2014 Jan 14.

Percutaneous closure of an iatrogenic ventricular septal defect following concomitant septal myectomy at the time of aortic valve replacement

Il Hwan Ryu  1 , Won Ho Kim  1 , Ah Jeong Ryu  1 , Min Gyu Kim  1 , Jae Woong Jeon  1 , Joo Seok Kim  1 , Jae Joon Lee  1 , Jin Ho Choi  2
Affiliations

Percutaneous closure of an iatrogenic ventricular septal defect following concomitant septal myectomy at the time of aortic valve replacement

Il Hwan Ryu et al. Korean Circ J. 2014 Jan.

Abstract

A 77-year-old female patient underwent aortic valve replacement (AVR) with concomitant septal myectomy and tricuspid annuloplasty. Her symptoms did not improve after a successful operation. Echocardiogram demonstrated the presence of an iatrogenic ventricular septal defect (VSD). It was muscular in location and not the usual AVR with membraneous type of VSD, suggesting a complication from the myectomy. Percutaneous closure of the VSD remained the only feasible option due to her poor overall medical status. A 14-mm Amplazter VSD occluder was deployed successfully, by means of the trans-septal technique. She has improved very well postoperatively.

Keywords: Heart septal defects; Septal occluder device.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Iatrogenic VSD assessment by echocardiography. A: parasternal long-axis view shows a muscular VSD (arrow), suggesting of a complication by myectomy, not AVR in which it is usually present with membraneous type of VSD. B: color Doppler imaging depicts a high-velocity jet between the left ventricle and right ventricle. C: the velocity and peak pressure gradient across the defect are measured at 4.78 m/s and 91.33 mm Hg, respectively. VSD: ventricular septal defect, AVR: aortic valve replacement, RV: right atrium, LV: left ventricle, Ao: aorta.
Fig. 2
Fig. 2
Placement of Percutaneous Amplatzer Muscular ventricular septal defect (VSD) occluder. A: a 0.035 inch extra-stiff guide wire (arrow) is advanced from the femoral vein through the defect, and into the left ventricle (LV) apex. B: the diameter of Amplazter VSD occluder is measured using an Amplazter sizing balloon II (arrow). C: the LV disc of the Amplazter VSD occluder (arrow) is deployed first in the LV. D: it has released the right ventricle (RV) disc of the device (arrow) in the RV by rotating the delivery cable in a counterclockwise direction.
Fig. 3
Fig. 3
Post-procedural echocardiography. A: parasternal long axis view shows the appropriate positioning of the Amplazter ventricular septal defect occluder. The device is seen as a dense crescent-like structure (arrow), at the left side of the interventricular septum. The left ventricular outflow tract is not obstructed. B: color Doppler imaging shows near-elimination of the left to right shunt after device delivery. RV: right ventricle, LV: left ventricle, LA: left atrium, Ao: aorta.
See this image and copyright information in PMC

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