Transjugular approach percutaneous closure: a preferred solution for challenging surgical management of ventricular septal rupture

TL;DR

This paper presents a successful case of using a transjugular percutaneous closure to treat a challenging ventricular septal rupture after a heart attack.

Contribution

The study demonstrates the feasibility of transjugular percutaneous closure as an alternative to surgery for high-risk patients with ventricular septal rupture.

Findings

A 20-mm ASD occluder device was successfully deployed to treat a large VSR in a high-risk patient.

Post-procedure, the patient showed clinical improvement and stable hemodynamics.

Follow-up imaging confirmed proper device placement with minimal residual shunt.

Abstract

Ventricular septal rupture (VSR) is a rare but life-threatening complication following myocardial infarction (MI). While traditional management typically involves surgical repair, percutaneous closure techniques are increasingly being considered, particularly in cases where surgery is challenging or patients are high risk.

We present the case of a 62-year-old male with anterior ST-segment elevation MI, complicated by a large VSR. Transthoracic echocardiography (TTE) revealed an 11.8-mm VSR, hypokinetic anteroseptal and anterior walls, and an ejection fraction of 52%. Surgical repair was considered high risk due to the patient’s advanced age, hypertension, anterior MI and apical VSR. Consequently, the heart team opted for a transjugular percutaneous closure approach. A 20-mm ASD occluder device was successfully deployed across the defect, as confirmed by cineangiography. Post-procedure, the patient showed clinical improvement, with resolution of the murmur and stabilization of hemodynamics. Follow-up TTE demonstrated proper occluder placement with minimal residual shunt.

This case highlights the feasibility and effectiveness of transjugular percutaneous closure for managing complex VSR post-MI, especially in patients unsuitable for surgical repair.

The online version contains supplementary material available at 10.1186/s43044-025-00638-y.

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