Ventricular septal defect (VSD)
Ventricular septal defect (VSD) is the most frequent congenital heart disease in adults but has become very infrequent given the new advancements and guidelines of PCI for ACS. We present a case of late presentation of a NSTEMI with acute thrombosis of the LAD, which was complicated by a VSD which was successfully percutaneously repaired.
Patient is an 82 yo woman with history of hypertension, diabetes type 2, ulcerative colitis who comes to the Emergency Room because of worsened chest pain for 4 days prior to her admission. She described her severe pain as typical, present in the precordial area and radiating to her left arm. Her vitals and physical exam were unremarkable. Her EKG showed TWI in the precordial leads and her initial troponin was 0.08. Her TTE showed hypokinesis od her anterior and anteroseptal walls and mildly reduced EF. Given her presentation and ongoing symptoms, patient underwent a left heart catheterization showing an acute occlusion of the mid-segment of her left anterior descending artery (LAD) s/p successful aspiration thrombectomy and stent placement.
Patient had no major post-op issues and she was discharged. However, 2 days later, she complained of malaise and SOB. She underwent another TTE that showed a muscular VSD. She subsequently benefited a successful percutaneous placement of a 35 mm Amplatzer Cribliform occluder (VSD closure device).Patient did well even 2 years later and her recent repeat TTE showed no shunt, properly placed VSD and no other significant findings.
Late presentation of acute myocardial infarction can have deleterious complications. Furthermore, prompt recognition and intervention of VSD post-MI can significantly reduce morbidity and mortality.