Post Myocardial Infarction: Ventricular Septal Perforation
Inferior Post Infarct VSD
Septal perforation after acute myocardial infarction (Post Infarct VSD) is a rare but fatal complication of acute myocardial infarction. The mortality rate of postinfarct VSD to conservative management is very high, whereas the mortality rate after surgical repair ranges from 21% to 60%. The mortality rate after surgical intervention nears 70% in the case of inferior defects. Recent advances in device development and availability of trans catheter approach to treat these patients have significantly improved the management approach. Understanding the morphology of the defect helps in assessing the suitability for device closure.
3D echocardiography gives detailed information into the morphologic variation of the defect and hence appropriate device development. Below are few examples.
Fig1. Post MI inferior VSD:View from the LV
Fig 2. Onface view of the interventricular septum demonstrating the extent of the defect
Fig 3: View from the RV aspect
Video of the post infarct VSD in an 85 year old lady considered unsuitable for device closure. Appropriate 3D assessment lead to developing a custom made device and adequate transcatheter closure of the defect
Pre and post deployment angiograms
75 year old lady with acute post infarct VSD (inferior) stabilized with intra aortic balloon pump. Transthoracic 3D images are displayed above. 2D images show the location and anatomic details best defined from 3D. The later images show how to evaluate the defect for device sizing and selecting appropriate device for closure.
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