Interventricular septal defect as a complication of a concomitant aortic valve replacement and aortocoronary bypass surgery

Ventricular septal defect (VSD) is a rare complication of surgical aortic valve replacement (AVR) and transcatheter aortic valve replacement (TAVI), with an incidence of 1%. An 81-year-old man underwent AVR with double aortocoronary bypass. Several hours after surgery haemo-dynamic instability accrued, and echocardiography showed a VSD. The patient underwent another surgery with the use of cardiopulmonary bypass. The VSD was closed through aortothomy, and annuloplasty of the tricuspid valve was performed. The postoperative period was complicated by atrioventricular block, with pacemaker implantation required. There are more possibilities for VSD treatment in the literature. On one hand, percutaneous device closure allows for a procedure without mechanical protheses explantation. On the other hand, surgical access through the aortothomy is useful in the case of a progressive and dynamic increase of the VSD and the proximity of the prothesis and the VSD. A combined approach for implantation of an occluder under visual inspection is presented as an additional applicable treatment strategy.