Transapical ischemic ventricular septal defect repair with simultaneous centrifugal left ventricular assist device placement: A case report

Introduction and importance: Post-infarct ventricular septal defect (PIVSD) is an often-fatal complication of myocardial infarction despite the use of temporary mechanical circulatory support. Case presentation: A 46-year-old male presented with myocardial infarction complicated by PIVSD. Clinical course was characterized by declining systolic function and hemodynamic instability. To provide hemodynamic support, a ventricular assist device was placed at surgical repair of the defect. The patient successfully recovered with no complications 21 months post-repair. He has undergone evaluation for heart transplantation. Clinical discussion: Mortality among patients with PIVSD is high. For patients with cardiogenic shock at the time of defect repair, concomitant ventricular assist device therapy shows promise to decrease morbidity through durable hemodynamic support following surgery. Conclusion: Placement of a durable left ventricular assist device (LVAD) at the time of PIVSD repair through a single ventriculotomy may be an effective strategy for this lethal condition.