ABSTRACT
Transcatheter closure of post-myocardial infarction ventricular septal defects (PMIVSDs) remains challenging because of the infrequency and severely ill nature of the patients referred. The GUSTO-1 investigators found that in the era of thrombolysis only 0.2% of acute myocardial infarctions are complicated by a VSD compared to 1 to 2% in the pre-thrombolytic era.1,2 Furthermore, the patients referred for transcatheter closure have usually been turned down for surgery because of severe co-morbidity, established cardiogenic shock, or advanced age. This sets the stage for a severely ill patient undergoing a relatively rarely performed procedure as an emergency. Patients turned down for surgery because of age rather than condition may do well with the transcatheter technique.
