Transcatheter closure of ventricular septal rupture with prolonged support of intra-aortic balloon pump after primary PCI: a case report

BMC Cardiovascular Disorders

Chuan Yang¹  Zhaoqing Sun¹  Deling Zou¹  Guangsheng Su¹  Wenyue Pang¹  Xinzhong Zhang¹  Jing Qi¹  Yong Sun² 

[1] Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, 110004, Shenyang, China;Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, 150086, Harbin, China;The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, 150086, Harbin, China;

关键词: Acute myocardial infarction;    Complication;    Ventricular assist device;    Intervention;    Case report;   

DOI  :  10.1186/s12872-021-02392-w

来源: Springer

【 摘 要 】

BackgroundVentricular septal rupture (VSR) is a rare but severe complication of acute myocardial infarction (AMI). For such cases, surgical repair is recommended by major guidelines, but not always possible for such cases.Case presentationA 72-year-old man presented to the emergency room. ECG showed the ST-segment was elevated by 2–3 mm in lead II, III, and aVF, with Q-waves. Coronary angiography (CAG) showed multi-vessel disease with a total occlusion of the right coronary artery (RCA) and severe stenosis of the left anterior descending artery (LAD). A diagnosis of acute inferior myocardial infarction was made. VSR occurred immediately after percutaneous coronary intervention (a 2.5 × 20 mm drug-eluting stent implanted in RCA), and the patient developed cardiogenic shock. An intra-aortic balloon pump (IABP) was used to stabilize the hemodynamics. Transthoracic echocardiography (TTE) revealed an 11.4-mm left-to-right shunt in the interventricular septum. An attempt was made to reduce the IABP augmentation ratio for weaning on day 12 but failed. Transcatheter closure was conducted using a 24-mm double-umbrella occluder on day 28. The patient was weaned from IABP on day 31 and underwent secondary PCI for LAD lesions on day 35. The patient was discharged on day 41. Upon the last follow-up 6 years later, CAG and TTE revealed no in-stent restenosis, no left-to-right shunt, and 51% left ventricular ejection fraction.ConclusionsProlonged implementation of IABP can be a viable option to allow deferred closure of VSR in AMI patients, and transcatheter closure may be considered as a second choice for the selected senior and vulnerable patients, but the risk is still high.

【 授权许可】

CC BY