Post-Infarct Ventricular Septal Defect

A post-infarct VSD is a rare post-MI complication that carries a high mortality and is best diagnosed through echocardiography. It is initially managed medically (reduction of the left-to-right shunt and maintenance of adequate cardiac output), with potential escalation to mechanical circulatory support and surgery. The keys to surgical management include careful myocardial protection, patch closure of the VSD by anchoring it to healthy tissue, addressing concomitant coronary artery disease if there is at-risk myocardium, and a tension-free patch closure of the VSD and ventriculotomy.