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case_images: Electrocardiography on admission.. Note: Electrocardiography showed pathologic Q wave with elevated ST segments in whole precordial and inferior leads.
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case_images: The electrocardiogram (ECG) showed Q wave in precordial whole leads (V1-V6) and ST elevation in II, V2-6 (Figure 1).
case_images: Echocardiography on admission.. Notes: Echocardiography showed muscular VSD of approximately 2 cm size. (A) Ventricular septal defect (arrow) and (B) further delineation with use of color-flow Doppler.. Abbreviations: LV, left ventricular; RV, right ventricular; VSD, ventricular septal defect.
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case_images: Echocardiography showed akinesia of LAD territory including left ventricular (LV) apex and mid to apical septum, anteroseptum apical lateral wall, inferior wall, anterior wall with moderate LV systolic dysfunction and muscular VSD of approximately 2 cm-size (Figure 2).
case_images: Coronary angiogram.. Note: Selective left coronary injection shows mid-left anterior descending total occlusion without any collateral vessels (arrow).
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case_images: Coronary angiography performed on the day of admission showed mid-LAD total occlusion (Thrombolysis in Myocardial Infarction, 0 flow) without collateral vessels and distal left circumflex total occlusion with antegrade collateral vessel (Figure 3).
case_images: Emergent operation for ventricular septal defect repair by two patch technique.. Note: A ventricular septal defect (arrow).
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case_images: However, emergent VSD repair surgery (two patch technique) was performed to control the left-to-right shunt with refractory heart failure (Figure 4).
case_images: Echocardiography after the operation.. Notes: Echocardiography showed remnant VSD after the operation. (A) Remnant VSD (arrow) and (B) further delineation with use of color-flow Doppler.. Abbreviations: VSD, ventricular septal defect; LV, left ventricular.
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case_images: Echocardiography showed remnant VSD due to highly friable septal tissue (Figure 5).
case_images: Percutaneous transcatheter AMPLATZER  Muscular VSD Occluder device inserted across ventricular septal defect.. Note: AMPLATZER  16 mm muscular VSD device was placed appropriately across the ventricular septal defect (arrow).. Abbreviations: VSD, ventricular septal defect; LV, left ventricular; RV, right ventricular.
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case_images: The device was placed at an appropriate site across the VSD and then released (Figure 6). Successful implantation of the device was confirmed by transthoracic echocardiography. The heart failure was controlled after device closure and the patient was discharged without complications 20 days after the procedure.