Percutaneous Closure of an Ischemic Ventricular Septal Rupture in a 73-Year-Old Man: A Case Report.

Abstract

BACKGROUND Acquired ventricular septal defect is an uncommon complication of myocardial infarction that can require surgical repair. Percutaneous closure techniques avoid the risks associated with major cardiac surgery, particularly in elderly patients. This report presents the case of a 73-year-old man with a post-infarction ventricular septal defect successfully treated by percutaneous closure. CASE REPORT A 73-year-old man was admitted with ST-elevation myocardial infarction. Coronary angiography revealed 2-vessel disease, and successful stenting of the left anterior descending artery was performed. Transthoracic echocardiography demonstrated an apical ventricular septal defect. Given the patient's hemodynamic stability, the heart team recommended delayed percutaneous closure. However, the patient requested voluntary discharge. He was readmitted 2 weeks later with dyspnea and chest pain. The defect was closed percutaneously due to technical feasibility, elevated surgical risk, and patient preference. Post-procedural recovery was uneventful, and he was in NYHA functional class I at outpatient follow-up. CONCLUSIONS Ischemic ventricular septal rupture is a rare but potentially fatal complication of transmural myocardial infarction, requiring prompt recognition and management by a heart team. Presentation ranges from chest pain or a new murmur to cardiogenic shock. Diagnosis relies on imaging modalities, including transthoracic or transesophageal echocardiography and cardiac magnetic resonance imaging. Management options include surgical and percutaneous closure, with ventricular septal rupture repair mortality exceeding 40%. Treatment selection depends on the patient's clinical status and the size, location, and complexity of the defect. This report highlights the role of percutaneous closure in post-infarction ventricular septal rupture and illustrates a successful outcome in an elderly patient.