Key result
Transcatheter closure of postinfarction VSD achieves ~93% implantation success despite some fatal multiorgan failure.
Why the study?
The possibility and safety of transcatheter closure of postinfarction ventricular septal defects at different times after acute myocardial infarction were not well established.
Observational (n=15)
Transcatheter closure of postinfarction ventricular septal defects is technically feasible but is associated with high in-hospital mortality in critically ill patients.
Supports feasibility of transcatheter post-MI VSD closure at varying intervals; leaves open optimal timing and need for controlled trials.
Aim: The study was designed to evaluate the possibility and safety of transcatheter closure of postinfarction ventricular septal defects in different periods after acute myocardial infarction. Methods: Over a period from 2010 to 2015 15 patients (11 females and 4 males) underwent transcatheter closure of postinfarction ventricular septal defects. The time from the onset of infarction to the intervention varied between 1 day and 6 months (mean 10.9 weeks). Three patients were treated in an acute phase of infarction (two weeks or less). The defect size ranged 7-24 mm (mean 13.5 mm), while the implanted devices sized 12-34 mm (mean 22.8 mm). The procedure and screening time amounted to 67-170 (mean 115.3) and 14-78 (mean 32.5) minutes respectively. Results: A successful device implantation occurred in all but one patient whose occluder was dislodged. This patient later underwent successful surgical VSD closure. Occluder implantation failed to improve the clinical status of two patients in a critical condition. They developed multiple organ failure and died at 2 and 9 days after the procedure. Conclusion: Transcatheter closure of postinfarction ventricular septal defects may be an alternative to surgery in patients with suitable anatomy and multiple comorbidities. However, in-hospital mortality remains high, even after successful occluder implantation.
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Khelimskiy et al. (2016) conducted an observational in postinfarction ventricular septal defects (n=15). Transcatheter closure was evaluated on successful device implantation. Transcatheter closure of postinfarction ventricular septal defects achieved successful device implantation in 93.3% (14/15) of patients, though 2 patients died from multiple organ failure.
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