PMC9836817_01
(a) ECG showing ST-segment elevation in the inferior leads with Q waves. (b) and (c) TTE showing a 18 mm VSR with left-to-right shunting by color-Doppler.
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fig1
An electrocardiogram was promptly performed, which revealed inferior ST-segment elevation with Q waves, horizontal ST depression in V1-3, and reciprocal ST depression in lateral leads, compatible with inferoposterior STEMI (Figure 1(a)). It revealed mild left ventricular (LV) systolic dysfunction with inferior and infero-septal akinesia and right ventricular (RV) extension; an 18 mm VSR, with left-to-right shunting by Doppler color-flow imaging; and mild pericardial effusion (Figures 1(b) and 1(c)).
(a) and (b) ICA showing a 50% stenosis of the mid-segment of the LAD and a mid-segment occlusion of the RCA (c). Coronary collaterals are a prognostically important adaptive response in coronary artery disease. Note its absence in (c), which correlate with a larger final infarct volume and an increased risk of mechanical complications. (d) Ventriculography revealing the presence of a LV-to-RV shunt.
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Invasive coronary angiography (ICA) documented proximal occlusion of dominant right coronary artery (RCA) and a 50% lesion of the mid-segment of the left anterior descending artery (LAD) (Figures 2(a), 2(b), and 2(c)). LV ventriculography showed the presence of a shunt with contrast passing from LV to RV (Figure 2(d)).
(a) and (b) Successful implantation of a 24 mm MemoPart  device across the VSR. (c) Ventriculography showing mild to moderate residual shunt.
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fig3
LV, and an atrial septal defect (ASD) occluder device 24 mm MemoPart  was implanted (Figures 3(a) and 3(b)). LV angiogram and TTE confirmed a stable device position, with no interference with atrioventricular valve function and mild to moderate residual shunt (Figure 3(c)). The procedure was performed at nighttime, and dedicated ventricular septal defect closure devices were not available on the shelf.