Multidisciplinary transcatheter rescue of post-infarction ventricular septal rupture in cardiogenic shock: expanding the role of percutaneous closure—case report

TL;DR

A 65-year-old woman with a severe heart condition was successfully treated with a delayed percutaneous closure of a ventricular septal rupture, avoiding surgery.

Contribution

Demonstrates the viability of delayed percutaneous closure as a life-saving alternative for high-risk patients with post-infarction ventricular septal rupture.

Findings

Delayed percutaneous closure with a CERA® occluder successfully treated a 11 mm ventricular septal rupture.

The patient improved clinically and was discharged after 20 days following the intervention.

Multidisciplinary collaboration and mechanical circulatory support were critical for successful management.

Abstract

Post-infarction ventricular septal rupture is a rare but often fatal mechanical complication of acute myocardial infarction, particularly when associated with cardiogenic shock and multiorgan dysfunction.

A 65-year-old woman presented in cardiogenic shock five days after initial chest pain. ECG showed ST-segment elevation in anterior and inferior leads. Coronary angiography revealed thrombotic occlusion of the proximal left anterior descending artery, successfully treated with primary percutaneous coronary intervention. Transthoracic echocardiography later revealed an 11 mm inferobasal ventricular septal rupture. Due to high surgical risk (EuroSCORE II >50%) in the setting of renal failure and recent dual antiplatelet therapy, the multidisciplinary Heart Team opted for delayed percutaneous closure. Fifteen days after symptom onset, a 16 mm CERA® occluder was successfully deployed with only trivial residual shunt. The patient showed rapid clinical improvement, was weaned from intra-aortic balloon pump and vasopressors, and discharged on Day 20 to cardiac rehabilitation.

This case illustrates the feasibility and efficacy of delayed percutaneous closure of post-infarction ventricular septal rupture in a critically ill patient. While surgery remains standard therapy, percutaneous closure offers a viable life-saving alternative in select high-risk patients, especially when delayed to allow scar formation. Mechanical circulatory support may serve as a bridge to intervention. Multidisciplinary Heart Team collaboration is essential for optimal individualized management.

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