ABSTRACT

With the universal implementation of early reperfusion therapies after myocardial infarction (MI), postinfarction ventricular septal defect (VSD) has become an uncommon complication after transmural MI. The first successful surgical repair was reported by Cooley and colleagues in 1956.1 Early approaches emphasized delayed repair, based on the tenet that necrotic tissue would organize over time, allowing sutures to be more securely placed around a fibrous margin. However, it is now recognized that potential surgical candidates are at risk of rapid clinical deterioration from the effects of multi-organ failure, and early repair prior to the onset or worsening of cardiogenic shock is now the recommended practice. In recent years, the majority of patients are initially managed with intra-aortic balloon pumps (IABP). There will be an increasing role for percutaneous VSD closure devices, either as a definitive treatment or as a stabilizing measure, in select patients based on anatomic considerations and hemodynamic stability at the time of presentation.