Percutaneous Post-Myocardial Infarction Ventricular Septal Rupture Closure: A Review

Ventricular septal rupture remains a rare, but most often lethal, complication of acute myocardial infarction. Current guidelines recommend emergent surgical repair of post-myocardial ventricular septal rupture, with concomitant coronary artery bypass grafting as indicated. Though surgery provides improved survival over medical management alone, mortality rates remain up to 60%. With technological advances, percutaneous closure has emerged as an alternative management option. In this review, we address patient selection, timing, success, mortality, and complications of transcatheter post-myocardial infarction ventricular septal rupture closure. Current data reveal a lower mortality as compared to surgical management. The optimal device for closure remains uncertain. Timing of closure >14 days after myocardial infarction appears to be associated with greater procedural success; however, delaying repair introduces a selection bias. Complications include device embolization, arrhythmia, residual shunting, and left ventricular rupture. Overall, a Heart Team approach should be taken when possible before proceeding with transcatheter post-myocardial infarction ventricular septal rupture closure. Emergent percutaneous closure should be considered in patients with large shunt or hemodynamic instability. In relatively stable patients, urgent percutaneous closure should be considered if patients are rendered unsuitable for surgical closure.