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Abstract

Background: Because of the fragility of the infarcted cardiac tissue, surgical therapy is technically challenging and yields poor results. Concurrent left ventricular aneurysm (LVA) with ventricular septal rupture (VSR) makes it even rarer and raises its mortality prediction score, making patients unlikely surgical candidates. In this case, we would like to discuss the possibility of successful percutaneous therapy of VSR with "Swiss cheese" morphology and LV apical aneurysm. Case Presentation: A 54-year-old female with VSR and LVA complicating recent extensive anterior ST-elevation myocardial infarction (STEM!) presented with cardiogenic shock SCAI В receiving intra-aortic balloon pump (IABP) despite optimal vasodilators. Echocardiography revealed LVA from mid inferoseptal, apical, to mid anterolateral segments as well as multiple echo gap, the largest being 16 mm. The surgical conference decided that such case was inoperable. Transcatheter VSR closure was then performed to close the largest hole with a 20-mm Amplatzer septal occluder. Echocardiography evaluation showed that the device was stowed in place with residual shunt on the edge of the device and apex. The patient's condition was stable and eventually IABP was successfully removed. Conclusion: Our case showed that percutaneous VSR closure was one of the options for improving LVA and VSR patient hemodynamic.

Keywords: Ventricular septal rupture, Swiss-cheese morphology, left ventricular apical aneurysm, percutaneous ventricular septal rupture closure, case report

List of Abbreviations

ASD Atrial Septal Defect

BID Twice per Day

CABG Coronary Angiography Bypass Surgery

CAG Coronary Angiography

CO Cardiac Output

CT Computed Tomography

eGFR Estimated Glomerular Filtration Rate

EuroSCORE IL European System for Cardiac Operative Risk Evaluation

hs-Trop T High Sensitive Troponin T

IABP Intra-Aortic Balloon Pump

ISDN Isosorbide Dinitrate

LAD Left Anterior Descending

LV Left Ventricle

LVA Left Ventricular Aneurysm

LVEDD Left Ventricular End Diastolic Diameter

LVEF Left Ventricular Ejection Fraction

MPA Mean Pulmonary Artery

NT pro BNP N-terminal Prohormone of Brain Natriuretic Peptide

OD Once per Day

PCI Percutaneous Coronary Intervention

REVIVED Revascularization for Ischemic Ventricular Dysfunction

RV Right Ventricle

STEMI ST-Elevation Myocardial Infarction

SVR Systemic Vascular Resistance

TID Three Times per Day

VSD Ventricular Septal Defect

VSR Ventricular Septal Rupture

Background

Acute ventricular septal rupture (VSR) typically occurs within the first week of a heart attack. This abnormality occurs rarely in 0.17-0.31% of people after the era of revascularization. Unfortunately, it is...

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