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European Heart Journal Advance Access originally published online on October 24, 2005
European Heart Journal 2006 27(10):1136; doi:10.1093/eurheartj/ehi536
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Magnetic resonance imaging after percutaneous closure of a ventricular septal defect complicating myocardial infarction

Holger Thiele1,*, Ingo Dähnert2 and Gerhard Schuler1

1 Department of Internal Medicine/Cardiology, University of Leipzig–Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
2 Department of Pediatric Cardiology, University of Leipzig–Heart Center, Leipzig, Germany

* Corresponding author. E-mail address: thielh{at}medizin.uni-leipzig.de

A 72-year-old man presented with dyspnoea (NYHA III). Medical history revealed a chest pain episode 3 months before presentation and the ECG showed persistent ST-elevation in the anterior leads. An apical ventricular septal defect (VSD) complicating myocardial infarction was diagnosed with transoesophageal echocardiography. Left and right heart catheterization showed a left-to-right shunt with a shunt–flow ratio (Qp:Qs) of 3:1, severe pulmonary hypertension, and an occluded left anterior descending coronary artery. Percutaneous closure of the VSD was performed with an umbrella device. The Amplatzer® occluder is a catheter implantable self-expanding device made from a nitinol wire mesh filled by polyester thread; two discs are linked together by a short (3 mm) connecting waist (Panel A). After successful implantation of a 25 mm device, cine MRI and delayed enhancement imaging were performed. Quantitative flow measurements, as well as right and left ventricular volumetry, revealed a post-procedural shunt–flow ratio Qp:Qs of 1.2:1. The horizontal long-axis view (Panel B) and apical short-axis view (Panel C) show the device in situ. Horizontal long-axis delayed enhancement imaging after injection of gadolinium-chelate revealed a transmural apical anterior myocardial infarction with the device in situ (Panel D). Imaging was performed on a 1.5 T scanner (Intera CV, Philips Medical Systems) using single breath-holds.

Percutaneous closure of an infarct-related VSD has recently become an alternative for surgical closure, which is associated with a high mortality. In clinical routine, follow-up is performed by echocardiography. MRI may be an alternative non-invasive diagnostic imaging tool to evaluate patients after interventional closure of a VSD.


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This Article
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27/10/1136    most recent
ehi536v1
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