Emiliano Fiori presents the case of a 70-year-old man with end-stage ischemic cardiomyopathy, post-anterior STEMI, supported by an LVAD implanted in 2022. He was admitted for heart failure symptoms including worsening dyspnea, jugular vein distension, and peripheral edema.
Diagnostic work-up revealed a periapical ventricular septal defect (VSD) with a left-to-right shunt, contributing to right ventricular failure and pulmonary hypertension. The diagnosis was confirmed through echocardiography, CT angiography, right heart catheterisation and invasive ramp testing. Multidisciplinary decision led to percutaneous VSD closure under general anesthesia at low LVAD speed to avoid device embolisation. Post-procedure, the patient showed functional improvement and decreased NT-proBNP levels, with imaging confirming successful closure and proper device positioning.
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