Percutaneous Swiss-Cheese Ventricular Septal Rupture Closure with Catastrophizing Left Ventricular Aneurysm and Non-Viable Myocardium: A Case Report

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Authors: Nabila Edhiningtyas Damaiati, Brian Mendel, Rina Ariani, Dafsah Arifa Juzar, Oktavia Lilyasari, Amin Tjubandi, and Radityo Prakoso
Page Range: 93-99
Published in: World Heart Journal, 15#2 (2023)
ISSN: 1556-4002

Table of Contents

ABSTRACT

Background: Because of the fragility of the infarcted cardiac tissue, surgical therapy is technically challenging and yields poor results. Concurrent left ventricular aneurysm (LVA) with ventricular septal rupture (VSR) makes it even rarer and raises its mortality prediction score, making patients unlikely surgical candidates. In this case, we would like to discuss the possibility of successful percutaneous therapy of VSR with “Swiss cheese” morphology and LV apical aneurysm. Case Presentation: A 54-year-old female with VSR and LVA complicating recent extensive anterior ST-elevation myocardial infarction (STEMI) presented with cardiogenic shock SCAI B receiving intra-aortic balloon pump (IABP) despite optimal vasodilators. Echocardiography revealed LVA from mid inferoseptal, apical, to mid anterolateral segments as well as multiple echo gap, the largest being 16 mm. The surgical conference decided that such case was inoperable. Transcatheter VSR closure was then performed to close the largest hole with a 20-mm Amplatzer septal occluder. Echocardiography evaluation showed that the device was stowed in place with residual shunt on the edge of the device and apex. The patient’s condition was stable and eventually IABP was successfully removed. Conclusion: Our case showed that percutaneous VSR closure was one of the options for improving LVA and VSR patient hemodynamic.

Keywords: Ventricular septal rupture, Swiss-cheese morphology, left ventricular apical aneurysm, percutaneous ventricular septal rupture closure, case report

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