Transcatheter closure of a post-myocardial infarction ventricular septal rupture using a parachute device.

(A) Before the procedure, large residual ventricular septal shunts could be seen between the occluder and the peak of apex (Online Video 1). (B) After the procedure, the shunts decreased significantly (Online Video 2). LV 1⁄4 left ventricle; RV 1⁄4 right ventricle. A 58-year-old man with exertional dyspnea (New York Heart Association class II) was admitted to our hospital. He suffered from acute anterior myocardial infarction 1 year earlier and had undergone percutaneous coronary intervention and closure of ventricular septal rupture (VSR) with an Amplatzer Septal Occluder (St. Jude Medical, St. Paul, Minnesota) 9 months before admission. Echocardiography taken on admission showed large residual apical ventricular septal shunts near the occluder (Figure 1A, Online Video 1) and left ventricular aneurysm, with left ventricular ejection fraction of 49%. An 85-mm Parachute device (CardioKinetix, Inc., Menlo Park, California) was used to restore the left ventricle and close the apical VSR simultaneously, with the method reported previously (1). After the procedure, the Qp/Qs ratio decreased from 1.8 to 1.2. An x-ray showed that the Parachute device was located at the left ventricular apex and the Amplatzer occluder intruded into the device (Figure 2). At 3-month follow-up, the patient’s symptom was relieved, and New York Heart Association class was improved to class I. Echocardiography demonstrated that apical ventricular septal shunts decreased significantly (Figure 1B, Online Video 2). The Amplatzer occluder intruded into the Parachute device, causing incomplete apposition of the device and a blood flow run into the partitioned apical cavity from left ventricular chamber (Figure 3), and then went through the apical ventricular septal (Figure 1B). Post-myocardial infarction VSR is a serious disease. Even if treated with surgery or percutaneous intervention, it is still associated with high mortality. Previously, VSR was percutaneously closed using double-umbrella devices (2), which were not