Delayed Repair of an Iatrogenic Perimembranous VSD After Redo Aortic Valve Replacement

BACKGROUND: Iatrogenic ventricular septal defect (VSD) is an uncommon complication of redo aortic valve surgery, particularly during prosthesis explantation near the membranous septum. CASE SUMMARY: A 71-year-old woman with a prior 19-mm bioprosthetic aortic valve underwent redo aortic valve replacement for severe prosthetic dysfunction. Explantation created a perimembranous VSD that was initially closed transaortically; intraoperative transesophageal echocardiography showed a trivial residual shunt. On postoperative day 5, transthoracic echocardiography revealed a new 0.5-cm VSD with left-to-right shunting. Emergent transtricuspid patch repair failed because of extreme septal tissue friability. Six weeks later, after fibrotic maturation, left ventricular-side patch closure with concomitant sutureless aortic valve replacement achieved complete closure. DISCUSSION: In stable patients, delayed repair of an iatrogenic VSD may enable durable closure when early repair fails because of friable tissue. TAKE-HOME MESSAGE: Timing of repair may determine surgical success in an iatrogenic VSD.