Yalçın Yalım, Zeybek Cenap, Onsel Ibrahim Ozgür, Bilal Mehmet Salih
Department of Pediatric Cardiology, Medicana International Hospital, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2011 Sep;39(6):491-4. doi: 10.5543/tkda.2011.01459.
Postmyocardial infarction ventricular septal defect (VSD) carries a high mortality and, even after successful surgery, residual defect is common. A 75-year-old woman was admitted with the diagnosis of hyperacute anterior myocardial infarction. Primary percutaneous intervention was performed by stenting of a totally obstructed segment in the proximal left anterior descending artery. The patient's condition deteriorated on the second postprocedural day with a 3/6 pansystolic murmur at the mesocardium. Echocardiography revealed an apical anteroseptal VSD and moderate pulmonary hypertension. She underwent surgical VSD closure with a Gore-Tex patch and coronary artery bypass grafting to the left anterior descending and circumflex arteries. The patient's condition continued to be unstable due to septicemia and hemodynamically significant residual VSD. After medical management of septicemia, the residual defect was successfully closed using a 10-mm Cardio-O-Fix septal occluder under fluoroscopic and transesophageal echocardiographic guidance. The clinical condition of the patient was then stabilized and there was no significant residual shunt on echocardiography on the third postprocedural day.
心肌梗死后室间隔缺损（VSD）死亡率很高，即使手术成功，残余缺损也很常见。一名75岁女性因超急性前壁心肌梗死入院。通过对左前降支近端完全阻塞节段进行支架置入术进行了初次经皮介入治疗。术后第二天患者病情恶化，在心前区可闻及3/6级全收缩期杂音。超声心动图显示心尖前间隔室间隔缺损和中度肺动脉高压。她接受了使用戈尔特斯补片的室间隔缺损手术闭合以及左前降支和回旋支的冠状动脉搭桥术。由于败血症和血流动力学上有意义的残余室间隔缺损，患者病情持续不稳定。在对败血症进行药物治疗后，在荧光镜和经食管超声心动图引导下，使用10毫米Cardio-O-Fix间隔封堵器成功闭合了残余缺损。然后患者的临床状况稳定，术后第三天超声心动图显示无明显残余分流。
