Ventricular Septal Defect (VSD) closure concomitant With Coronary Artery Bypass Grafting (CABG): a rare case

Firman Al Faruq; Heroe Soebroto; Oky Revianto Sediono Pribadi

doi:10.15562/bmj.v12i3.4939

Ventricular Septal Defect (VSD) closure concomitant With Coronary Artery Bypass Grafting (CABG): a rare case

Firman Al Faruq ,

Heroe Soebroto ,

Oky Revianto Sediono Pribadi ,

pdf |
DOI: https://doi.org/10.15562/bmj.v12i3.4939 |
Published: 2023-11-14

Abstract

Link of Video Abstract: https://youtu.be/LZnyDExOr9w

Background: Ventricular septal defect (VSD) is the most common congenital cardiac anomaly in children and the second most common in adults. It often coexists with other cardiovascular conditions, including hypertension, coronary artery disease (CAD), and heart failure. This presents unique challenges in diagnosis and treatment.

Case Presentation: We present the case of a 46-year-old woman with a previously undiagnosed VSD complicated by a ventricular septal rupture and prior myocardial infarction. Coronary artery bypass grafting (CABG) and VSD repair were performed. Unexpectedly, the VSD turned out to be an atrial septal defect (ASD) of the muscular type. The repair was successful using mattress sutures and a 0.6mm PTFE patch. Two-coronary-artery bypass was also performed. The patient's recovery was uneventful, with no residual VSD.

Conclusions: Discovering a large, asymptomatic VSD in an elderly patient is uncommon. Simultaneous repair of VSD and CAD yields favorable surgical outcomes, highlighting the importance of thorough preoperative evaluation in such cases.

References

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Wu W, He J, Shao X. Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990–2017. Medicine (Baltimore). 2020;99(23):1-10.
Giamberti A, Lo Rito M, Conforti E, Varrica A, Carminati M, Frigiola A, et al. Acquired coronary artery disease in adult patients with congenital heart disease: A true or a false problem?. J Cardiovasc Med. 2017;18(8):605–609.
Khazi FM, Al-Safadi F, Karaly Y, Siddiqui NR, Al-Zamkan B, Aljassim O. Management issues during postinfarction ventricular septal defect and role of perioperative optimization: A case series. Ann Card Anaesth. 2019;22(1):30–34.
Assenza GE, McElhinney DB, Valente AM, Pearson DD, Volpe M, Martucci G, et al. Transcatheter closure of post-myocardial infarction ventricular septal rupture. Circ Cardiovasc Interv. 2013;6(1):59–67.
Tai S, Tang JJ, Tang L, Ni YQ, Guo Y, Hu XQ, et al. Management and outcome of ventricular septal rupture complicating acute myocardial infarction: What is new in the era of percutaneous intervention?. Cardiol. 2019;141(4):226–232.
Mubarik A, Iqbal AM. Ventricular Septal Rupture. StatPearls. 2021. [Available from: https://www.ncbi.nlm.nih.gov/books/NBK534857/] [Accessed on 20th October 2023].
Cui Y, Hao X, Huang F, Li J, Lai Y, Zhou Q. Coronary Artery Bypass Grafting in Adults with Congenital Heart Disease. 2010;11(1):629–632.
Mongeon F, Burkhart HM, Ammash NM, Connolly HM. Indications and Outcomes of Surgical Closure of Ventricular Septal Defect in Adults. JCIN. 2010;3(3):290–297.
Tayama E, Fujita S, Ueda T, Imasaka K, Enomoto N, Onitsuka H, et al. Case Report Ventricular Septal Defect in an Octogenarian : A Case Report of VSD Surgical Repair Concomitant with Coronary Artery Bypass and Valvular Surgery. 2012;2012(1):1-9.
Daniels CJ, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, et al. Circulation AHA / ACC GUIDELINE 2018 AHA / ACC Guideline for the Management of Adults With Congenital Heart Disease A Report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. 2019.
Patel ND, Kim RW, Pornrattanarungsi S, Wong PC. Morphology of intramural ventricular septal defects: Clinical imaging and autopsy correlation. Ann Pediatr Cardiol. 2018;11(3):308-311.
Lopez L, Houyel L, Colan SD, Anderson RH, Béland MJ, Aiello VD, et al. Classification of Ventricular Septal Defects for the Eleventh Iteration of the International Classification of Diseases-Striving for Consensus: A Report From the International Society for Nomenclature of Paediatric and Congenital Heart Disease. Ann Thorac Surg. 2018;106(5):1578-1589.
Dakkak W, Oliver TI. Ventricular Septal Defect. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023. [Available from: https://www.ncbi.nlm.nih.gov/books/NBK470330/] [Accessed on 20th October 2023].
Pinto NM, Waitzman N, Nelson R, Minich LL, Krikov S, Botto LD. Early Childhood Inpatient Costs of Critical Congenital Heart Disease. J Pediatr. 2018;203(1):371-379.
Manuaba IBAP, Santika NGAPL, Prabawa IPY, Bhargah A, Darmayani S, Wu CC. Virtual patient simulation method for learning and assessment in cardiology field. Bali Medical Journal. 2020;9(3):660-663.
Wardana OP, Utomo MT, Etika R, Handayani KD, Hariastawa IGBA, & Fitriati M. Successful management of Congenital Diaphragmatic Hernia (CDH) in an 8-day-old infant with moderate persistent pulmonary hypertension, moderate muscular Ventricular Septal Defect (VSD), and small Patent Ductus Arteriosus (PDA). Bali Medical Journal. 2022;11(3):1289–1292.
Sanjaya INH, Pemayun CIM, Purwanti NWD, Sakuntari MDV, Gianni NPN, Putri NLMDMC, et al. Single Umbilical Artery (SUA) - prenatal sonography diagnosis and vascular imaging features postnatal cord: a case report. Bali Medical Journal. 2021;10(1):8–10.
Rampengan SH, Rosmaningtyas CAA. A patient with large ostium primum atrial septal defect who underwent open heart surgical closure with pericardial patch: a case report. Bali Medical Journal. 2023;12(2):1934–1939.
Garg N, Nayyar M, Khouzam RN, Salem SA, Ardeshna D. Peri-procedural antibiotic prophylaxis in ventricular septal defect: a case study to re-visit guidelines. Ann Transl Med. 2018;6(1):18.
Cresti A, Giordano R, Koestenberger M, Spadoni I, Scalese M, Limbruno U, et al. Incidence and natural history of neonatal isolated ventricular septal defects: Do we know everything? A 6-year single-center Italian experience follow-up. Congenit Heart Dis. 2018;13(1):105-112.
Cantinotti M, Assanta N, Murzi B, Lopez L. Controversies in the definition and management of insignificant left-to-right shunts. Heart. 2014;100(3):200-205.

[1] Dakkak W, Oliver TI. Ventricular Septal Defect. StatPearls. 2023. [Available from: https://www.ncbi.nlm.nih.gov/books/NBK470330/] [Accessed on 2nd October 2023].

[2] Wu W, He J, Shao X. Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990–2017. Medicine (Baltimore). 2020;99(23):1-10.

[3] Giamberti A, Lo Rito M, Conforti E, Varrica A, Carminati M, Frigiola A, et al. Acquired coronary artery disease in adult patients with congenital heart disease: A true or a false problem?. J Cardiovasc Med. 2017;18(8):605–609.

[4] Khazi FM, Al-Safadi F, Karaly Y, Siddiqui NR, Al-Zamkan B, Aljassim O. Management issues during postinfarction ventricular septal defect and role of perioperative optimization: A case series. Ann Card Anaesth. 2019;22(1):30–34.

[5] Assenza GE, McElhinney DB, Valente AM, Pearson DD, Volpe M, Martucci G, et al. Transcatheter closure of post-myocardial infarction ventricular septal rupture. Circ Cardiovasc Interv. 2013;6(1):59–67.

[6] Tai S, Tang JJ, Tang L, Ni YQ, Guo Y, Hu XQ, et al. Management and outcome of ventricular septal rupture complicating acute myocardial infarction: What is new in the era of percutaneous intervention?. Cardiol. 2019;141(4):226–232.

[7] Mubarik A, Iqbal AM. Ventricular Septal Rupture. StatPearls. 2021. [Available from: https://www.ncbi.nlm.nih.gov/books/NBK534857/] [Accessed on 20th October 2023].

[8] Cui Y, Hao X, Huang F, Li J, Lai Y, Zhou Q. Coronary Artery Bypass Grafting in Adults with Congenital Heart Disease. 2010;11(1):629–632.

[9] Mongeon F, Burkhart HM, Ammash NM, Connolly HM. Indications and Outcomes of Surgical Closure of Ventricular Septal Defect in Adults. JCIN. 2010;3(3):290–297.

[10] Tayama E, Fujita S, Ueda T, Imasaka K, Enomoto N, Onitsuka H, et al. Case Report Ventricular Septal Defect in an Octogenarian : A Case Report of VSD Surgical Repair Concomitant with Coronary Artery Bypass and Valvular Surgery. 2012;2012(1):1-9.

[11] Daniels CJ, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, et al. Circulation AHA / ACC GUIDELINE 2018 AHA / ACC Guideline for the Management of Adults With Congenital Heart Disease A Report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. 2019.

[12] Patel ND, Kim RW, Pornrattanarungsi S, Wong PC. Morphology of intramural ventricular septal defects: Clinical imaging and autopsy correlation. Ann Pediatr Cardiol. 2018;11(3):308-311.

[13] Lopez L, Houyel L, Colan SD, Anderson RH, Béland MJ, Aiello VD, et al. Classification of Ventricular Septal Defects for the Eleventh Iteration of the International Classification of Diseases-Striving for Consensus: A Report From the International Society for Nomenclature of Paediatric and Congenital Heart Disease. Ann Thorac Surg. 2018;106(5):1578-1589.

[14] Dakkak W, Oliver TI. Ventricular Septal Defect. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023. [Available from: https://www.ncbi.nlm.nih.gov/books/NBK470330/] [Accessed on 20th October 2023].

[15] Pinto NM, Waitzman N, Nelson R, Minich LL, Krikov S, Botto LD. Early Childhood Inpatient Costs of Critical Congenital Heart Disease. J Pediatr. 2018;203(1):371-379.

[16] Manuaba IBAP, Santika NGAPL, Prabawa IPY, Bhargah A, Darmayani S, Wu CC. Virtual patient simulation method for learning and assessment in cardiology field. Bali Medical Journal. 2020;9(3):660-663.

[17] Wardana OP, Utomo MT, Etika R, Handayani KD, Hariastawa IGBA, & Fitriati M. Successful management of Congenital Diaphragmatic Hernia (CDH) in an 8-day-old infant with moderate persistent pulmonary hypertension, moderate muscular Ventricular Septal Defect (VSD), and small Patent Ductus Arteriosus (PDA). Bali Medical Journal. 2022;11(3):1289–1292.

[18] Sanjaya INH, Pemayun CIM, Purwanti NWD, Sakuntari MDV, Gianni NPN, Putri NLMDMC, et al. Single Umbilical Artery (SUA) - prenatal sonography diagnosis and vascular imaging features postnatal cord: a case report. Bali Medical Journal. 2021;10(1):8–10.

[19] Rampengan SH, Rosmaningtyas CAA. A patient with large ostium primum atrial septal defect who underwent open heart surgical closure with pericardial patch: a case report. Bali Medical Journal. 2023;12(2):1934–1939.

[20] Garg N, Nayyar M, Khouzam RN, Salem SA, Ardeshna D. Peri-procedural antibiotic prophylaxis in ventricular septal defect: a case study to re-visit guidelines. Ann Transl Med. 2018;6(1):18.

[21] Cresti A, Giordano R, Koestenberger M, Spadoni I, Scalese M, Limbruno U, et al. Incidence and natural history of neonatal isolated ventricular septal defects: Do we know everything? A 6-year single-center Italian experience follow-up. Congenit Heart Dis. 2018;13(1):105-112.

[22] Cantinotti M, Assanta N, Murzi B, Lopez L. Controversies in the definition and management of insignificant left-to-right shunts. Heart. 2014;100(3):200-205.

Ventricular Septal Defect (VSD) closure concomitant With Coronary Artery Bypass Grafting (CABG): a rare case

Abstract

References

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