Structural Heart Disease > Cases
|Transcatheter Closure of a Postmyocardial Infarction Ventricular Septal Rupture with an Amplatzer Septal Occluder|
|- Operator: Mahsa Fadavi, MD|
| - Relevant clinical history and physical exam:
A 70 years old physician with a large acute anterior myocardial infarction who underwent thrombolytic therapy with streptokinase, but chest pain and ST segment elevation persisted. then Emergent coronary angiography performed several hours after admission and showed severe three vessel diseases. (Figure 1, Figure 2) Echocardiography showed anteroseptal akinesia and LV dysfunction( LVEF=25% ) , with mild MR and without ventricular septal rupture. . He underwent emergency coronary artery bypass grafting . The patient remained stable until the third post-CABG day when he developed tachycardia, hypotension, dyspnea, pulmonary edema, and a new pansystolic murmur heard over the left sternal border. Intravenous inotropes were started. Repeated bedside echocardiography showed anteroseptal akinesia and a mid-septal VSD with mild MR and without pericardial effusion. (Figure 3) Transoesophageal echocardiography (TEE) and cardiac catheterization showed a 8 mm diameter VSD with significant left to right shunt, pulmonary hypertension (45mm Hg). The inferior and posterior left ventricular walls contracted well but septum and apex were akinetic.then he underwent amplatzer septal occluder.
- Relevant test results prior to catheterization:
- Relevant catheterization findings:
- Procedural step: