Iatrogenic VSD, Closure Attempt With Complications, and Ultimate Success

Background: Iatrogenic postsurgical ventricular septal defect (VSD) is a rare complication of surgical aortic valve replacement (SAVR). Case Summary: A patient presented with left-sided heart failure due to an initially missed postoperative VSD after redo SAVR. A moderate shunt in the perimembranous area was discovered. During the initial closure attempt, an intracardiac echocardiography catheter caused dislodgment of a ventricular pacing lead. A later closure attempt was successful with a discrete residual defect and improved patient status. Discussion: Postsurgical VSD is considered exceedingly rare after SAVR and presents a therapeutic challenge because of patient frailty during postsurgical recovery. Key device closure considerations include defect geometry, rim sufficiency, and avoidance of oversizing. Take-Home Messages: Rare postoperative VSD after SAVR is a potential cause of prolonged recovery and heart failure symptoms. The preferred treatment alternative is percutaneous device closure. Use of intracardiac echocardiographic guidance generally increases safety but may rarely cause complications.