Background-Ventricular septal rupture (VSR) after acute myocardial infarction (AMI) is a potentially lethal mechanical complication of acute coronary syndromes. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. We report our single-center experience with double-umbrella device percutaneous closure of post-AMI VSR. Methods and Results-In this single-center, retrospective, cohort study, patients who underwent transcatheter closure of post- AMI VSR between 1988 and2008 at Boston Children's Hospital were included. Data were analysed according to whether the patients underwent direct percutaneous VSR closure or closure of a residual VSR after a previous surgical approach. Primary outcome was mortality rate at 30 days. Clinical predictors of primary outcome were investigated using univariate logistic regression. Thirty patients were included in the study (mean age, 67±8 years). A total of 40 closure devices were implanted. Major periprocedural complications occurred in 4 (13%) patients. Cardiogenic shock, increasing pulmonary/ systemic flow ratio, and the use of the new generation (6-arm) STARFlex device all were associated with higher risk of mortality. The Model for End-Stage Liver Disease Excluding international normalized ratio (MELD-XI) score at the time of VSR closure seemed to be most strongly associated with death (odds ratio, 1.6; confidence interval, 1.1-2.2; P<0.001). Conclusions-Transcatheter closure of post-AMI VSR using CardioSEAL or STARFlex devices is feasible and effective.The MELD-XI score, a marker of multiorgan dysfunction, is a promising risk stratifier in this population of patients. as definitive single therapy, as a bridge to surgery, or for closure of residual defects after surgical repair in selected cases. [8][9][10] To date, the majority of studies of transcatheter closure of post-AMI VSR have reported on the use of Amplatzer atrial septal defect and ventricular septal defect occluders (AGA Medical Corporation, Plymouth, MN). 8-10Recent studies have investigated the utility of the Model for End-Stage Liver Disease (MELD) score as a potential predictor of poor outcomes in patients with heart disease.11,12 A logarithmic function of creatinine, total bilirubin, and international normalized ratio, the MELD score in many ways serves as a simpler marker of multiple organ dysfunction. The modified MELD score Excluding international normalized ratio (MELD-XI score) was validated against the original MELD score and has been shown to be equally able to predict mortality in patients with liver cirrhosis waiting for liver transplantation. 13In this study, we report the outcomes of transcatheter closure of post-AMI VSR using different double-umbrella devices in a consecutive cohort of patients referred during the course of 2 decades to our institution. Methods PopulationIn this single-center, retrospective, cohort study, patients referred to our institution for transcatheter closure of post-AMI VSR between 1988 and 2008 were included. Patients w...

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In adults with Fontan surgery, exercise test data can identify patients at increased risk of midterm morbidity and mortality.