Endoscopic Closure of Iatrogenic Ventricular Septal Defect After 2 Previous Aortic Valve Replacements.

BACKGROUND

A 79-year-old male patient previously had undergone 2 aortic valve replacements via median sternotomy.

CASE SUMMARY: He presented with progressive shortness of breath shortly after the second procedure. This led to the identification of an iatrogenic perimembranous ventricular septal defect on a transthoracic echocardiogram. A heart team discussion concluded that the defect was not amenable for percutaneous closure. An endoscopic minimally invasive surgical closure was performed, and the patient had a quick recovery.

DISCUSSION: To the best of our knowledge, this is the first case of an iatrogenic ventricular septal defect closure via an endoscopic approach. This highlights the feasibility of using this approach in complex redo cardiac conditions to avoid further sternotomies.

TAKE-HOME MESSAGE: Heart teams should consider an endoscopic approach with complex cases specifically if there is no interventional option available.