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Post MI VSD Intracardiac Double Patch Repair
A 64-year-old man was admitted to the emergency room with acute inferior wall infarction, which was confirmed by echocardiogram and ECG. The patient was immediately taken for primary percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA). He was discharged but continued to have breathlessness and was readmitted in 2008. The patient was found to have a basal aneurysm and a left to right shunt with posterior post-myocardial infarction (MI) ventricular septal defect (VSD). He was optimized on medical management and discharged. The patient was admitted again in 2010 with the same symptoms. Echocardiogram, angiography, and stress thallium confirmed previous findings, and he was advised to continue with medical management. During this period, his symptoms worsened from NYHA class II to NYHA class IV. In 2014, echocardiogram confirmed post-MI posterior VSD, increased left ventricle volume, and worsening of left ventricular and right ventricular function.
In 2016, the patient was admitted to the emergency room in cardiogenic shock and ventricular tachycardia. He was optimized and taken for coronary angiography, which confirmed double vessel disease and posterior VSD. He was stabilized with an intra-aortic balloon pump and taken for PCABG with LIMA to D1 and LAD, and posterior post-MI VSD double patch repair. The surgery was uneventful and an automatic implantable cardioverter defibrillator (AICD) was subsequently put in place. The patient was discharged and is now leading a normal life.