Page 33 - Journal of Structural Heart Disease Volume 4, Issue 3

Meeting Abstracts
90
7. Figure 1
Learning Points of the Procedure: Kissing stent technique using stents dilatable to adult size can be an e ective treatment for young patients with recurrent postoperative complex PA stenosis.
8. PERCUTANEOUS REPAIR OF POST-INFARCTION VENTRICULAR SEPTAL RUPTURE IN A PATIENT WITH MYOCARDIAL INFARCTION AND REFRACTORY HEART FAILURE
Cheng-Hung Chiang1, Chin-Chang Cheng1, Wei-Chun
Huang1, Guang-Yuan Mar1, Ming-Chih Lin2
1 Kaohsiung Veterans General Hospital; Department of Internal Medicine; Division of Cardiology
2 Taichung Veterans General Hospital; Pediatric; Pediatric Cardiology
History and Physical: A 62-year-old male su ered from acute chest pain and dyspnea for one week. He had the history of hypertension and was a smoker. He visited emer- gent department and desaturation without cardiogenic shock was noted. Physical examination revealed grade IV/ VI pansystolic murmur over left lateral sternal border and bilateral crackles.
Imaging: Electrocardiogram revealed sinus tachycar- dia with poor R wave progression. Chest X-ray revealed pulmonary edema with bilateral pleural e usion. Echocardiography revealed hypokinesia of left ventricu- lar (LV) apex and anterior wall with aneurysm formation, LV ejection fraction around 40 %, and the presence of two sites of ventricular septal rupture (VSR), which were located at middle inferoseptal wall (Figure 1A) and apical septal wall (Figure 1B). Computed tomography angiography nd- ings were compatible with echocardiography. (Figure 1C and 1D). Coronary angiography revealed total occlusion of middle left anterior descending (LAD) artery (infarcted related artery) and chronic total occlusion of proximal right coronary artery.
Indication for Intervention: Surgical intervention with cor- onary artery bypass graft and VSR repair was suggested. However, he declined our suggestion.
Intervention: We performed percutaneous coronary intervention over middle LAD with a drug-eluting stent deployed on the 5th day after admission. Then, due to refractory heart failure, we performed percutaneous ven- tricular septal defect (VSD) occluder implantation on the
Journal of Structural Heart Disease, April 2018
Volume 4, Issue 2:85-113