TITLE:
Recurrent Stroke after Percutaneous Placement of Post-Infarct Septal Occluder Device
AUTHORS:
Suguru Ohira, B. S. Matan Grunfeld, Amanda Hetzel, Rohinton J. Morris
KEYWORDS:
Ischemic Heart Disease, Post-Infarct Ventricular Septal Defect, Percutaneous Closure
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.12 No.9,
September
8,
2022
ABSTRACT: Surgical intervention for post-infarct ventricular septal defect (VSD) is
a challenging procedure due to patients’ complex preoperative conditions. While
percutaneous VSD closure can be considered as an alternative to surgical repair,
complete closure of the defect remains difficult and is associated with various
procedural complications. We report a rare case of a patient with postoperative residual
shunts who experienced recurrent stroke episodes, requiring surgical
intervention for repair. The patient, a 71-year-old female, developed acute
anterior myocardial infarction and post-infarct VSD. Percutaneous closure with
a 14-mm Amplatzer VSD occluder device was performed, yet the closure was
incomplete. Following discharge, she developed multiple embolic stroke episodes,
likely stemming from the residual VSD, which led to the surgical extraction of
the device and VSD repair. Fibrous tissue was found to be solely attached to
the core and right ventricle side of the device, whilst no fibrous tissue was
observed on the side of the left ventricle. The patient has not experienced new
neurological symptoms at an 18-month follow-up. Thus, it is
paramount to keep in mind that an embolic stroke may occur in the setting of
percutaneous post-infarct VSD closure. Surgical repair of VSD with device
removal should be considered as a treatment option to such a complex case.