Postmyocardial infarction ventricular septal defect: too many doubts still to solve

Abstract

To the Editor, This is the case of a young man with a postmyocardial infarction large ventricular septal defect (VSD) surgically repaired 10 days after venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy. The patient still had a large residual VSD that triggered a situation of refractory congestion due to pulmonary hyperflow that was successfully treated with percutaneous closure. The patient gave his informed consent so this case could be published anonymously. This is the case of a 46-year-old man without a past medical history and inferior wall myoscardial infarction and Killip class I. Cardiac catheterization confirmed the presence of multivessel disease. The culprit lesion found at the proximal right coronary artery [TIMI grade-0 flow (Thrombolysis in Myocardial Infarction)] was revascularized with a drug-eluting stent. The patient was admitted to the coronary care unit, and progressed into cardiogenic shock. Several transthoracic and transesophageal echocardiographic studies revealed the presence of severe biventricular dysfunction and a large, basal inferoseptal VSD (50 mm) of anfractuous non-restrictive trajectory (Qp/Qs ratio of 3) (figure 1). Figure 1. Large inferoseptal ventricular septal defect up to the apical segments as seen on the transthoracic echocardiography (A) with a 50 mm maximum diameter as seen on the transesophageal echocardiography. (B) The long (C)...