Case Report Percutaneous Closure of Postinfarction Ventricular Septal Defect: Cardiac Magnetic Resonance-Guided Case Selection and Postprocedure Evaluation Nigel J. Artis, MD, a John Thomson, MD, b Sven Plein, PhD, a and John P. Greenwood, PhD a a Division of Neuronal and Cardiovascular Remodelling, University of Leeds, Leeds, United Kingdom b Department of Congenital Cardiology, Leeds General Infirmary, Leeds, United Kingdom ABSTRACT Despite modern surgical techniques, complications and early mortality remain high following postinfarction ventricular septal defect (VSD) repair. It is now possible to close these acquired defects percutane- ously using, for example, the Amplatzer postinfarct muscular VSD device. Cardiovascular magnetic resonance is an important tool in determining appropriate case selection and device sizing as it can provide a multicomponent assessment of the VSD anatomy, ventricu- lar volumes and function, infarct extent, and left-to-right shunt calculations. RÉSUMÉ En dépit des techniques chirurgicales modernes, les complications et la mortalité précoce demeurent élevées après la réparation d’une communication interventriculaire (CIV) postinfarctus. Il est maintenant possible de fermer ces communications acquises de manière percu- tanée en utilisant, par exemple, le dispositif Amplatzer pour la CIV musculaire postinfarctus. L’imagerie cardiovasculaire par résonance magnétique est un outil important pour la sélection des cas appropriés et le calibrage du dispositif puisqu’elle peut fournir une évaluation multifactorielle de l’anatomie de la CIV, de la fonction et des volumes ventriculaires, de l’étendue de l’infarctus et des calculs de shunt gauche-droit. Although the occurrence of ventricular septal defect (VSD) following acute myocardial infarction (MI) is a relatively infrequent mechanical complication, it is still associated with high mortality. Data from recent clinical trials indi- cated a 30-day mortality of 87% in the Should We Emer- gently Revascularize Occluded Coronaries in Cardiogenic ShocK? (SHOCK) study and 74% in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO)-1 trial. 1,2 Despite modern surgical techniques, complications and early mortality remain high due to the friable nature of the infarcted tissue and surgical patch dehiscence. The first report of percutaneous VSD closure was described in the late 1980s, 3 although all patients died before discharge. With developments in device technology, in particular, the Amplatzer postinfarct muscular VSD device, there have been a number of successful small series reports, largely in the post-MI population but also in cases of VSD caused by trauma. 4 The largest series to date reported successful device deployment in 16 of 18 cases and a 30-day mortality of 28%. 5 We describe how 2 patients who presented late to hospital after an acute MI were evaluated by cardiovascular magnetic resonance (CMR) both at baseline for their suitability for per- cutaneous VSD closure and afterward to evaluate postproce- dure success. (Written informed consent was obtained from both patients for publication of this case report and any accom- panying images. A copy of the written consent is available for review by contacting the Editor-in-Chief of this journal.) Case Presentations Case 1 A 78-year-old woman was admitted 4 days after an episode of central chest pain. Her electrocardiogram (ECG) showed inferolateral Q waves, and cardiac biomarkers were elevated, consistent with a late-presentation MI. Physical examination revealed hypotension, pulmonary edema, and a loud paraster- nal pansystolic murmur. A transthoracic echocardiogram re- Received for publication December 15, 2010. Accepted January 25, 2011. Corresponding author: Dr J.P. Greenwood, Academic Unit of Cardiovas- cular Medicine, G-floor, Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom. Tel.: +44 113 3925404; fax: +44 113 3925405. E-mail: j.greenwood@leeds.ac.uk See page 869.e5 for disclosure information. Canadian Journal of Cardiology 27 (2011) 869.e3– 869.e5 www.onlinecjc.ca 0828-282X/$ – see front matter © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.cjca.2011.01.018