An Endoscopic Solution to a Residual Postinfarct Ventricular Septal Defect

Postmyocardial infarction ventricular septal defect (VSD) is a life-threatening complication. It is usually considered an emergency that is traditionally treated with a surgical closure. The mortality of surgical repair in the acute phase can be as high as 70%. This high mortality rate is reduced to 25% if the surgical closure is delayed for a few weeks. A considerable percentage of surgeons will refrain from performing this surgery due to the poor outcomes. Recently, a percutaneous option of using an off-label septal occlusion device has occurred, but it also carries high mortality rates. Patch dehiscence was reported by many centers which indicates the progressive nature of the disease. This occurs mainly following surgery in the acute phase. this video, the authors present an interesting case of postmyocardial infarction VSD which was initially treated surgically with a pericardial patch closure. Subsequently, a patch dehiscence resulted in an intractable heart failure. A septal occlusion device was used, but due to the complexity of the VSD, the device dislodged into the right ventricle and could not be retrieved. The heart team discussion led to the utilization of the authors’ minimal access expertise to access the VSD and perform closure through a right minithoracotomy. The outcome was successful, and there was no flow through the new VSD patch during two years of follow-up. The patient experienced minimal dyspnea of New York Heart Association Classification 0-I and was recently discharged from surgical follow-up.ReferencesShahreyar M, Akinseye O, Nayyar M, Ashraf U, Ibebuogu UN. Post-myocardial infarction ventricular septal defect: a comprehensive review. Cardiovasc Revasc Med. 2018 Nov 20.Faccini A, Butera G. Techniques, timing, and prognosis of transcatheter post myocardial infarction ventricular septal defect repair. Curr Cardiol Rep. 2019 Jul 1;21(7):59.Boi A, Cocco D, Sanna F, Rossi A, Fele GS, Tumbarello R, et al. Post myocardial infarction ventricular septal defect closure by a percutaneous septal occluder device after unsuccessful surgical closure: never lose hope. Cardiovasc Revasc Med. 2019 Jul 7.Sakaguchi G, Miyata H, Motomura N, Ueki C, Fukuchi E, Yamamoto H, et al. Surgical repair of post-infarction ventricular septal defect ―findings from a Japanese National Database―. Circ J. 2019 Sep 11:CJ-19.