Percutaneous ventricular assist device support in a patient with a postinfarction ventricular septal defect

• Published in: Texas Heart Institute journal Vol. 35; no. 1; pp. 46 - 49
• Main Authors: Gregoric, Igor D, Bieniarz, Mark C, Arora, Harvinder, Frazier, O H, Kar, Biswajit, Loyalka, Pranav
• Format: Journal Article
• Language: English
• Published: United States Texas Heart Institute 2008
• Subjects: Case Reports; Echocardiography, Transesophageal; Heart-Assist Devices; Humans; Male; Middle Aged; Suture Techniques; Ventricular Septal Rupture - diagnostic imaging; Ventricular Septal Rupture - physiopathology; Ventricular Septal Rupture - surgery; Ventricular Septal Rupture - therapy; heart septal defects, ventricular/complications/etiology/physiopathology/surgery/therapy; time factors; intra-aortic balloon pumping; heart-assist devices; Cardiac surgical procedures; myocardial infarction/complications; ventricular septal rupture, post-infarction/complications/etiology/surgery; hemodynamics; shock, cardiogenic/etiology/therapy
• ISSN: 0730-2347; 0730-2347

Complications of acute myocardial infarction have decreased in number and severity due to the application of early thrombolytic coronary revascularization techniques. Nonetheless, the mortality rate associated with these complications remains high. Ventricular septal rupture is one of the complications that can occur after myocardial infarction. In the treatment of postinfarction ventricular septal rupture, the need for immediate closure to avoid acute hemodynamic compromise must be weighed against the need for delayed repair to enable the acutely necrotic myocardium to organize and to develop fibrotic tissue. We report the use of a minimally invasive TandemHeart percutaneous ventricular assist device for 18 days in a 58-year-old man who experienced postinfarction ventricular rupture. The hemodynamic support provided by the device allowed time for left ventricular recovery before attempted percutaneous closure of the ventricular septal rupture and after definitive surgical repair of the septal defect. To our knowledge, this is the 1st reported use of the TandemHeart for support before and after repair of a postinfarction ventricular septal rupture.