Surgical management of ventricular septal rupture post device migration: a case report

Ventricular septal rupture (VSR) following myocardial infarction is a rare but life-threatening complication. While percutaneous closure offers a less invasive option, it remains technically challenging in posterior defects due to anatomical constraints. This case report emphasizes the limitations of device-based closure in such settings and reinforces the role of surgery as the definitive management. : We report the case of a 58-year-old male who developed a posterior ventricular septal rupture following an acute inferior wall myocardial infarction. Initial management included percutaneous device closure of the VSR. However, the patient developed persistent residual shunting and device migration, which resulted in its entanglement with the tricuspid valve apparatus and worsening heart failure. The patient subsequently underwent successful surgical repair through device extraction, infarct exclusion technique along with tricuspid valve replacement. Postoperative recovery was uneventful, and follow-up echocardiography confirmed complete closure of the defect with preserved biventricular function. This case underscores the limitations of percutaneous closure in posterior VSRs and supports surgical repair as the more reliable and definitive treatment. This case is unique due to extensive device migration into the tricuspid valve apparatus, necessitating combined device extraction, infarct exclusion repair, and tricuspid valve replacement—an uncommon combination in posterior VSR. Medium-term follow-up demonstrated stable cardiac function and no residual shunting.