Abstract
BACKGROUND: We present a case of postinfarct ventricular septal defect (VSD) presenting with exertional breathlessness, progressing to an index emergency presentation of biventricular heart failure and pulmonary embolism without shock. CASE SUMMARY: Multimodality cardiac imaging demonstrated a postinfarct muscular VSD in the midinferior septum measuring 9 mm, with a pulmonary-to-systemic flow ratio of 2.5. Percutaneous transjugular VSD closure was successfully undertaken using a 16-mm Amplatzer postinfarct VSD occluder, with robust clinical outcomes to date. DISCUSSION: This case highlights the need to consider exertional breathlessness as an angina equivalent, the utility of multimodality cardiac imaging in preprocedural planning, and the safety, efficacy, and durability of transcatheter closure for chronic ischemic VSD. TAKE-HOME MESSAGE: This case adds to the literature on the growing role of transcatheter closure as a reasonable alternative to surgical closure in this population.