Percutaneous Closure of Post-Infarction Ventricular Septal Rupture: A Review of Patient Selection, Techniques and Outcomes

Abstract

Post-infarction ventricular septal rupture (PIVSR) represents one of the most lethal complications of acute myocardial infarction. This narrative review examines current evidence supporting percutaneous closure as an alternative to surgical repair. Optimal patient selection depends on defect characteristics, hemodynamic stability, and surgical risk. Simple, apical defects smaller than 24 mm with adequate tissue rims favor percutaneous approaches, while large (>35 mm), complex, or multiple defects typically require surgery. Timing critically influences outcomes, delaying intervention 2-4 weeks post rupture when tissue has stabilized consistently improves survival compared to early closure. Contemporary series report 30-day mortality rates of 15-30% for percutaneous closure in selected patients versus 40-60% for emergency surgery. Device selection must match septal anatomy, with dedicated post-infarction VSD occluders preferred over adapted congenital devices. Technical success rates reach 70-100%, though residual shunting remains common. Current evidence supports percutaneous closure as a viable option that reduces procedural morbidity and enables staged management in high-risk patients. Success requires multidisciplinary planning, comprehensive imaging assessment, and surgical backup availability. While mortality remains high due to underlying myocardial damage, percutaneous approaches offer meaningful benefits for carefully selected patients when optimal timing and techniques are employed.