Percutaneous treatment of a ventricular septal defect caused by MINOCA

Abstract

We present a case of a 78-year-old female with a history of hypertension, paroxysmal atrial fi brillation and ischemic stroke which was admitted due to an hour-long chest pain with ECG changes indicating sinus rhythm and a newly formed LBBB. Subsequently a ventricular septal defect (VSD) was discovered which we successfully treated percutaneously. At admission, echocardiography revealed septo-apical hypokinesis with an accompanying reduced left ventricular ejection fraction of 38%, in addition to the mid-ventricular septal defect (7/14 mm in size) causing a signifi cant left to right shunt (QP/QS = 1.8/1.0). Coronary angiography demonstrated lack of obstruction of the coronary vessels – MINOCA. Rapid response and Intensive care treatment, including Intra-Aortic Balloon Catheter insertion, lead to LV-functional improvement and hemodynamic stabilization. A dual access approach through the right jugular vein and right radial artery was used and eventual closure of the VSD was achieved with an Occlutech ASD occluder (20.5/16.5 mm), inserted via the venous introducer, while under constant angiographic and transesophageal echo guidance. Immediate VSD shunt elimination was disclosed by EchoCG and angiography. Overall, an uneventful in-hospital stay and six months event-free follow-up period were registered including further EchoCG which confi rmed lack of major cardio-vascular events and the stable position of the occluder, without a visible shunt.

Keywords

• MINOCA
• VSD
• MI
• percutaneous treatment of VSD pos