APerventricular device closure of post-myocardial infarction ventricular septal defect: Can it combine best of both worlds!

Introduction: Post myocardial infarction ventricular septal defect (VSD) is a rare but dreadful complication of acute myocardial infarction. Current management of this complication has high morbidity and mortality rates. A hybrid approach (perventricular device closure) to high risk congenital muscular VSD has shown promising results. We report first case of a perventricular device closure of post infarct VSD by Amplatzer post infarct muscular VSD device. Case Report: A 52-year-old male was referred to us for rapidly progressive dyspnea. He had anterior wall myocardial infarction, complicated by post infarct VSD. His coronary angiography revealed 90 % lesion in left anterior descending (LAD) artery. Perventricular device closure of VSD (Amplatzer post infarct muscular VSD device) and graft to the LAD were performed using a beating heart technique. His postoperative stay was complicated by an enlarged secondary post infarct VSD. It was closed by percutaneous technique. He was discharged in stable condition. He is in compensated heart failure at 1 year follow up. Conclusion: Perventricular approach to congenital muscular VSD is an established procedure. Applying this approach to post infarct VSD can also effectively manage this dreadful complication. Combination of surgical and percutaneous techniques might be less traumatic with better outcome.