Abstract

Percutaneous Device Closure of Post-Myocardial Infarction Ventricular Septal Rupture (VSR) – Avoiding AV loop formation: Unlooping the mystery. A Case Series

Author(s): Mirza Mohd Kamran

Background: Ventricular Septal Rupture (VSR) is a catastrophic complication following acute Myocardial Infarction (MI), with mortality rates exceeding 80% if untreated. Surgical repair, though effective, is associated with high perioperative mortality, particularly in unstable patients. It has a bimodal incidence, with peak occurrences in the first 24 hours and at day’s 3-5 post-acute myocardial infarction. In the post-thrombolytic and percutaneous coronary intervention era, incidence of post myocardial infarction VSR is less than 0.5% with in hospital and 30-day mortality relating to VSR, ranging from 40% to 90% depending on management technique. T his study is a retrospective review from a tertiary level dedicated cardiac referral centre in South India. We are reporting four cases performed in our centre wherein VSR was closed with different devices with special emphasis on avoiding the formation of Arteriovenous (AV) loop and restricted use of contrast agent over a period spanning one year between February 2023 and January 2024. All patients were followed up post procedure at regular intervals with transthoracic echocardiograms and 12-lead electrocardiograms for a minimum period of 12 months. 

Results: All these cases mentioned in our study underwent a complete closure of their respective lesions with no evidence of residual shunt. None of these patients had any major complications, prolong stay, or any vascular injuries. All patients completed minimum 12-months follow-up and were doing well without any residual shunts. 

Conclusion: As far as conclusion of this paper is concerned, we suggest that device closure of VSR without the use of contrast and avoiding AV loops is a feasible and effective approach, as demonstrated by these successfully completed cases. This technique minimizes procedural risks, reduces contrast-induced nephropathy, and avoids complications associated with AV loops. Careful imaging guidance and meticulous procedural planning are crucial to ensuring success. Our experience highlights the potential of this method as a safer alternative for high-risk patients, paving the way for broader application in structural heart interventions.