Transcatheter Closure of Post-Myocardial Infarction Ventricular Septal Rupture Using an Atrial Septal Defect Occluder.

OBJECTIVE

To describe the procedural strategy and technical considerations for transcatheter closure of post-myocardial infarction ventricular septal rupture (VSR) using an atrial septal defect (ASD) occluder in a patient unsuitable for surgical repair.

KEY STEPS: An elderly, frail patient with postinfarction VSR and cardiogenic shock was stabilized with an intra-aortic balloon pump. Given the high surgical risk, transcatheter closure was performed after a 14-day delay to allow infarcted tissue stabilization. Multimodality imaging was used to assess defect morphology and rim adequacy. An ASD occluder was deployed under echocardiographic guidance, reducing shunt flow and improving hemodynamics.

POTENTIAL PITFALLS: Wire entrapment in the tricuspid subvalvular apparatus may cause tricuspid regurgitation. Careful wire manipulation and appropriate snaring techniques are essential. Adequate rim assessment is also critical.

TAKE-HOME MESSAGE: Transcatheter VSR closure using an ASD occluder is a feasible alternative in selected inoperable patients, particularly when dedicated VSD devices are unavailable.