Excerpt

A 73-year-old female underwent percutaneous coronary intervention (PCI) for the mid-left anterior descending artery (LAD) (Fig. 1a, b). After a stent was implanted in the mid-LAD, the third septal branch was occluded, and her creatinine kinase peaked at 847 mg/dl. At 6 months’ follow-up, she complained of breathlessness. Contrast-enhanced multidetector computed tomography (MDCT) revealed patent mid-LAD stent, spontaneous reperfusion of the third septal branch, and a previously undetected ventricular septal defect (VSD) at the middle level of the muscular portion. The volume-rendering fusion image of the left coronary artery and two-dimensional myocardium in diastole demonstrated that the third septal branch perfused the entire VSD (Fig. 1c). Although she was hemodynamically stable, echocardiography detected clinically significant pulmonary hypertension and the calculated Q_p/Q_s was 2.42. A consultation with cardiovascular surgeons concluded that transcatheter closure was the best candidate because of reasons mentioned below. After a written informed consent and approval from Institutional Review Board (IRB) at Sendai Kousei Hospital, we performed a percutaneous repair of VSD (Fig. 1d).

…