Post-myocardial infarction ventricular septal defect closure with Gore Cardioform atrial septal defect occluder to improve tissue interactions: case report

BACKGROUND: Gore Cardioform Atrial Septal Defect Occluder (GCA) is composed of a platinum-filled nitinol wire frame covered with expanded polytetrafluoroethylene (ePTFE). This makes the device highly occlusive and resistant to residual shunts through the device, as well as conforming well to the surrounding anatomy. In defects with poor rims to hold a device for closure or where one of the ‘rims’ is the free wall of the left ventricle, such as in a post-infarct apical ventricular septal defect (VSD), successful closure with standard nitinol mesh devices can be unachievable. CASE SUMMARY: We present the occlusion of a post-myocardial infarction VSD with a GCA device in a critically ill patient at risk for closure failure and intravascular haemolysis with conventional nitinol mesh devices. The device conformed well to the anatomy even in the absence of an apical interventricular septum. DISCUSSION: GCA can be used for intracardiac high-velocity shunts in selected cases where conventional devices are unsuitable due to haemolysis or poor tissue and poor rims. With growing experience using GCA for the closure of atrial septal defects, interventionists should consider the potential advantages of ePTFE material and apply them to other lesions where these could be beneficial for patients.