Delayed closure of ventricular septal defect with prolonged mechanical support
  • Dawood Shehzad
    Internal Medicine, University of South Dakota, Sioux Falls, USA
  • Mustafa Shehzad
    Internal Medicine, Hackensack University Medical Center, Hackensack, USA
  • Muhammad Ahmad
    Department of Medicine, Khyber Medical College, Peshawar, Pakistan,
  • Abdul Wassey
    Internal Medicine, Shifa College of Medicine, Islamabad, Pakistan
  • Noor Zara
    Internal Medicine, Shifa College of Medicine, Islamabad, Pakistan
  • Humna Younis
    Internal Medicine, Holy Family Hospital, Rawalpindi, Pakistan
  • Haider Ali Babar Khan
    Internal Medicine, Shifa College of Medicine, Islamabad, Pakistan

Keywords

Ventricular septal defect, myocardial infarction, mechanical circulatory support, LVAD

Abstract

Introduction: Ventricular septal defect (VSD) is a severe complication following acute myocardial infarction (MI) resulting from mechanical disruption of the interventricular septum due to extensive myocardial necrosis. Despite advances in management, the mortality rate approaches 50%. We report a case of a 58-year-old male with VSD following MI who was successfully treated with a delayed surgical approach after haemodynamic support using Impella.
Case description: A 58-year-old man with type 2 diabetes mellitus and hypertension presented with three days of chest pain. Testing revealed late presenting acute anterior ischaemic infarction and left-to-right shunt in the apical ventricular septum. Urgent cardiac catheterisation showed near-total occlusion of the left anterior descending artery. An Impella CP® was placed before angioplasty with a drug-eluting stent to optimise haemodynamics. After a multidisciplinary discussion, the Impella CP® was upgraded to Impella 5.5®, and surgery was delayed allowing for scar formation. The patient remained in the intensive care unit, where he underwent physical therapy, showing improvements in exercise tolerance by the time of surgery. He underwent a left ventriculotomy with a successful repair via an endocardial patch 28 days after initial presentation. Post-operative recovery was uneventful, with the patient discharged five days later, reporting no physical limitations one month post-discharge.
Conclusion: The successful management of VSD post-MI relies on interdisciplinary collaboration, careful timing of surgical intervention and the strategic use of mechanical support devices such as the Impella. This case highlights the potential for favourable outcomes when tailored treatment approaches are employed.

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    Published: 2024-05-13
    Issue: 2024: Vol 11 No 6 (view)


    How to cite:
    1.
    Shehzad D, Shehzad M, Ahmad M, Wassey A, Zara N, Younis H, Khan HAB. Delayed closure of ventricular septal defect with prolonged mechanical support. EJCRIM 2024;11 doi:10.12890/2024_004549.