Technical Considerations for the Percutaneous Management of Post-MI Ventricular Septal Rupture

Percutaneous techniques in managing post-MI ventricular septal rupture (VSR) have given recourse to patients deemed at high or prohibitive risk. Given the rarity of this catastrophic complication, experience is limited. VSR anatomy – with its complex 3D shape and more emergent presentation – is dissimilar to its congenital counterparts, leading to unique imaging and procedural challenges. We review the literature on percutaneous device closure of post-infarction VSR and, using practical illustrative cases, describe a systematic planning and technical approach for performing this complex procedure.