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Войти в исследования JACC. Case reports · 2026
The Snubbed Complication: Why Postinfarction Ventricular Septal Defect Management Lacks Evidence-Based Guidance in 2026.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Corona Silvia, Lamarche Yoan, Ibrahim Reda, Henri Christine, Pellerin Michel, Ben Ali Walid, Noly Pierre-Emmanuel
Аннотация
BACKGROUND: The management of postinfarction ventricular septal defect (VSD) is contentious, especially when complicated by cardiogenic shock and concomitant severe aortic stenosis, with no clear guidelines.
CASE SUMMARY: A 73-year-old woman presented with cardiogenic shock due to a large postinfarction VSD (Qp:Qs = 5) and unsuspected severe aortic stenosis. A percutaneous strategy was attempted, but the patient died from a residual shunt and multiorgan failure.
DISCUSSION: Three management strategies were initially considered: Viewpoint 1 advocated for immediate combined surgery (VSD repair, aortic valve replacement, coronary artery bypass grafting), arguing for a definitive, single-stage correction given the patient's profile. Viewpoint 2 proposed venoarterial extracorporeal membrane oxygenation as a bridge to delayed surgery, prioritizing stabilization and tissue healing to reduce the high risk of operating on acute, friable myocardium. Viewpoint 3 deemed surgery and extracorporeal membrane oxygenation prohibitively risky, favoring a staged transcatheter approach (balloon valvuloplasty followed by VSD closure) to circumvent the morbidity of open surgery.
TAKE-HOME MESSAGES: Postinfarction VSD management requires urgent, multidisciplinary consensus. All strategies carry significant risks, and percutaneous solutions are limited by tissue friability in the acute phase.
CASE SUMMARY: A 73-year-old woman presented with cardiogenic shock due to a large postinfarction VSD (Qp:Qs = 5) and unsuspected severe aortic stenosis. A percutaneous strategy was attempted, but the patient died from a residual shunt and multiorgan failure.
DISCUSSION: Three management strategies were initially considered: Viewpoint 1 advocated for immediate combined surgery (VSD repair, aortic valve replacement, coronary artery bypass grafting), arguing for a definitive, single-stage correction given the patient's profile. Viewpoint 2 proposed venoarterial extracorporeal membrane oxygenation as a bridge to delayed surgery, prioritizing stabilization and tissue healing to reduce the high risk of operating on acute, friable myocardium. Viewpoint 3 deemed surgery and extracorporeal membrane oxygenation prohibitively risky, favoring a staged transcatheter approach (balloon valvuloplasty followed by VSD closure) to circumvent the morbidity of open surgery.
TAKE-HOME MESSAGES: Postinfarction VSD management requires urgent, multidisciplinary consensus. All strategies carry significant risks, and percutaneous solutions are limited by tissue friability in the acute phase.