Extract

A 59-year old man presented with acute myocardial infarction complicated by ventricular septal rupture (VSD) and mitral papillary muscle rupture. The VSD was repaired with a bovine pericardial patch and mitral valve was replaced (Medtronic 27 mm Mosaic bioprosthesis). Three years later, the patient complained of shortness of breath and exercise intolerance. A residual muscular VSD was detected by echocardiography (Panel A, Supplementary data online, VideoS1), with a QP/QS ratio of 2.0 as calculated by both echocardiography and oxymetry methods. VSD orifice area was 0.33 cm2 by three-dimensional transthoracic echocardiography (Panel D). Using a modified parasternal view to minimize the angle between the ultrasound beam and the VSD flow, the proximal isovelocity surface area (PISA) method allowed calculating a 0.40 cm2 VSD orifice area: the convergence radius was 0.95 cm with an aliasing velocity of 29.7 cm/s (Panel E, Supplementary data online, VideoS2) and maximal velocity across the VSD defect was 416 cm/s (Panel F). Assuming an oversizing ratio of 2, an Occlutech mVSD Occluder ®12/19 mm was selected as transcatheter closing device (Panel B). There was no residual shunt (PanelC, Supplementary data online, VideoS3), and the patient became asymptomatic.

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