Recurrent Stroke after Percutaneous Placement of Post-Infarct Septal Occluder Device

作     者：Suguru Ohira B. S. Matan Grunfeld Amanda Hetzel Rohinton J. Morris Suguru Ohira;B. S. Matan Grunfeld;Amanda Hetzel;Rohinton J. Morris

作者机构：Division of Cardiothoracic Surgery Department of Surgery Westchester Medical Center New York Medical College Valhalla NY USA Division of Cardiac Surgery Department of Surgery Thomas Jefferson University Hospital Philadelphia PA USA 

出 版 物：《World Journal of Cardiovascular Surgery》 (心血管外科国际期刊（英文）)

年 卷 期：2022年第12卷第9期

页      面：191-195页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Ischemic Heart Disease Post-Infarct Ventricular Septal Defect Percutaneous Closure 

摘      要：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.