Ventricular septal defect complicating acute myocardial infarction: diagnosis and management. A Clinical Consensus Statement of the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the ESC Working Group on Cardiovascular Surgery

Ventricular septal defects are a rare complication after acute myocardial infarction with a mortality close to 100% if left untreated. However, even surgical or interventional closure is associated with a very high mortality and currently no randomized controlled trials are available addressing the optimal treatment strategy of this disease. This state-of-the-art review and clinical consensus statement will outline the diagnosis, hemodynamic consequences and treatment strategies of ventricular septal defects complicating acute myocardial infarction with a focus on current available evidence and a focus on major research questions to fill the gap in evidence. Graphical Abstract Top panel: Clinical course of ventricular septal defect complicating acute myocardial infarction. Middle panel: left: Echocardiographic visualization of a myocardial infarction ventricular septal defect (MI-VSD); right: major clinical characteristics of MI-VSD. Lower panel: left: MI-VSD treatment by surgery or percutaneous device closure; right: gaps in evidence and potential clinical trial design in MI-VSD. IRA, infarct-related artery; MCS, mechanical circulatory support; RCT, randomized controlled trial; SCAI, Society for Cardiovascular Angiography and Interventions shock stage classification.