Real-Time Three-Dimensional Transthoracic Echocardiography as a Decision-Making Tool for the Management of Postmyocardial Infarction Ventricular Septal Rupture: Guiding the Percutaneous Transcatheter Closure

Postmyocardial infarction ventricular septal rupture (PI-VSR) is a rare but lethal complication of acute myocardial infarction (AMI). The diagnosis and management of AMI remain challenging. When VSR is suspected, transthoracic and/or transesophageal echocardiography at patient's bedside is a test of choice for early diagnosis and therapeutical guidance. We aim to discuss the management of patients with VSR due to AMI with the focus on transcatheter closure management guided by real-time three-dimensional (RT3D) transthoracic echocardiography (TTE). A 64-year-old male patient was diagnosed with recent anterolateral ST elevation myocardial infarction and complication intra VSR as its complication. After remeasurement of the defect by TTE, we found an 8-11 mm defect in VSR. We performed transcatheter closure for VSR guided by RT3D TTE using Septal Occluder device No. 14. Evaluation after the procedure by TTE revealed that the device was well-seated. Percutaneous closure of PI-VSR may be considered in hemodynamically unstable patients if the risk of surgery is deemed to be too high or the anatomy is amenable to device insertion. RT3D echocardiography allows better delineation of the size and shape of the rupture, while serves as a guide during percutaneous transcatheter PI-VSR closure.