Percutaneous closure of post-myocardial infarction ventricular septal defects: A single centre experience

Background: Ventricular septal defect (VSD) is a serious complication of myocardial infarction (MI), occurring in about 0.2% of cases. Untreated, mortality in high and early surgical repair is difficult because of friable necrotic tissue. Percutaneous closure may be an alternative treatment option in selected patients. Methods: We report our complete single centre experience of percutaneous post-MI VSD closure using the Amplatzer device. The VSD was closed under general anaesthesia with fluoroscopic and transoesophageal echocardiographic guidance. Clinical characteristics and outcomes are reported. Results: The five patients were aged from 66 to 76 years. Closure was attempted from 1 to 64 days post-MI. VSD closure was performed in two patients after surgical patch dehiscence (infero-apical and infero-basal VSDs). The procedure was successful in four patients, with failure to cross the interventricular septum in one. Thirty-day and 12-month survival was 3/5 (60%); no patient undergoing VSD closure early post-MI survived, whereas 3/3 in whom the procedure was undertaken >14 days post-MI survived, suggesting that it may be appropriate to delay attempts at percutaneous VSD closure after MI. Conclusion: Percutaneous VSD closure post-MI appears to be a viable alternative to surgical repair, with favourable outcomes if it can be undertaken >14 days post-infarct.