Abstract 1697: Transcatheter Closure of Postinfarction Ventricular Septal Defects: A Series of 22 Cases
Background: Immediate surgical repair of ventricular septal defect (VSD) complicating acute myocardial infarction is associated with high mortality. Percutaneus device closure of postinfarction VSDs (PIVSD) using the Amplatzer system appears to be safe and effective in patients treated for a residual shunt after initial surgical closure of a PIVSD. Concerning primary transcatheter closure of a PIVSD early after diagnosis, reported data are rare. To our best knowledge, we report the largest series of primary transcatheter closure of a PIVSD.
Methods and Results: A transcatheter closure of PIVSD was performed from 09/2003 to 03/2007 in 22 consecutive patients (10 men, 12 women, mean age 70 ± 8 years, range 48 – 84). Outcome parameters included procedural success, occurrence of procedure- or device-related complications and overall mortality. The mean time between myocardial infarction and percutaneous device closure was 6.0 ± 1.5 days. Cardiogenic shock was present in 50 % of patients on admission. The mean Qp:Qs ratio pre-closure was 3.1:1. Successful deployment of the device was achieved in 17 of 22 (78%) patients. Left ventricular rupture was the most common complication during device delivery. Four closure devices dislocated into the right ventricle (between day one and four months after closure). The overall mortality was 68% with a mortality of 36% for patients presenting without cardiogenic shock. At long-term follow-up six patients are alive and well.
Conclusions: In patients with PIVSD that are not candidates for surgical closure due to high morbidity and/or cardiogenic shock, transcatheter closure offers an important therapeutic option in patients facing an otherwise grim outcome without treatment. However, further trials with larger series of patients are required to assess long-term efficacy and compare the results with those of surgical closure.