Concomitant Transventricular Mitral Valve Replacement in Posterior Postinfarction Ventricular Septal Defect

Background: Postinfarction ventricular septal defect is a life-threatening complication of myocardial infarction. In some cases, the septal defect reaches the posterior base of the left ventricle close to the papillary muscles and does not allow for sufficient anchoring of a pericardial patch. This poses a challenge as to the management strategy. We present a treatment concept consisting of a standard transapical closure of the ventricular septal defect and a simultaneous replacement of the mitral valve through the same access. This technique allows the anchoring of a pericardial patch in healthy myocardial tissue following the excision of the papillary muscles and the mitral valve. To our knowledge, there have been no other attempts at such a procedure.