Endovascular occlusion of recanalyzed post-infarction ventricular septal defect complicated by device migration (case report)

DOI: https://doi.org/10.25512/DIR.2017.11.1.10

For quoting:
Kochkina K.V., Shabala D.Yu., Mashtakova O.B., Protopopov A.V. "Endovascular occlusion of recanalyzed post-infarction ventricular septal defect complicated by device migration (case report)". Journal Diagnostic & interventional radiology. 2017; 11(1); 74-78.

authors:

Kochkina K.V.

Shabala D.Yu.

Mashtakova O.B.

Protopopov A.V.

keywords:

myocardial infarction complications

post-AMI VSD

endovascular VSD closure

Abstract:

Ventricular septal defect after myocardial infarction (post-MI VSD) is one of the most rare and lethal complication.

We present a case report of patient with recurrent VSD, 7 months after coronary artery bypass graft with cardiosurgical correction of post-MI VSD. Due to the high risk of re-operation, it was decided to perform endovascular closure of VSD.

Despite acceptable stability test, after delivery system disconnection - migration of occluder to left ventricular occurred. All efforts to retrieve device were not successful, due to strong fixation of the device in anterior leaflet chordal tendons of mitral valve (MV). The presence of 12 mm occluder didn't influence on existed MV insufficiency, so the decision to leave this device in place and to implant the bigger one to VSD was made. 14 mm occluder was successfully implanted, with immediate reduction of left-right shunt and normalization of pulmonary artery pressure. Follow-up period is 3 years - patient doesn't have any complaints. Ejection fraction 55%, mitral insufficiency 30% by volume, device is fully endothelialyzed.

Endovascular VSD occlusion can be effectively used in case of post-surgery re-occurence. In cases of migration of endovascular devices, thorough functional analysis should be performed for choosing the best strategy of further actions. In this clinical case the decision to leave the device in LV didn't cause any negative outcomes for the patient.

References

1. Koh A.S., Loh YJ., Lim YP., Le Tan J. Ventricular septal rupture following acute myocardial infarction. Acta Cardiol. 2011;66(2):225-30.

2. Crenshaw B.S., Granger C.B., Birnbaum Y et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction (GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators). Circulation. 2000;101:27-32.

3. Serpytis P, Karvelyte N., Serpytis R. et al. Postinfarction ventricular septal defect: risk factors and early outcomes. Hellenic J Cardiol. 2015;56(1):66-71.

4. Arnaoutakis G.J., Zhao Y, George T.J. et al. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2012; 94:436-443.

5. Assenza G.E., McElhinney D.B., Valente A.M. et al. Transcatheter closure of post-myocardial infarction ventricular septal rupture. Circ Cardiovasc Interv. 2013;6:59-67.

6. Calvert PA., Cockburn J., Wynne D. et al. Percutaneous closure of postinfarction ventricular septal defect: in-hospital outcomes and long-term follow-up of UK experience. Circulation. 2014;129:2395-402.

7. Deja M.A., Szostek J., Widenka K. et al. Post infarction ventricular septal defect - can we do better? Eur J Cardiothorac Surg. 2000;18:194-201.

8. Takahashi H., Arif R., Almashhoor A., et al. Longterm results after surgical treatment of postinfarction ventricular septal rupture. Eur J Cardiothorac Surg. 2015;47(4):720-724.

9. Holzer R., Balzer D., Lock Qi-Ling Cao K., Hijazi Z.M. Device closure of muscular ventricular septal defects using the Amplatzer muscular ventricular septal defect occluder. J Am Coll Cardiol. 2004;43:1257-1263.