A Ventricular Septal Defect (VSD) following an acute Myocardial Infarction (MI) is a devastating mechanical complication. Suspicions should arise when acute heart failure develops suddenly in patients with acute MI. While the incidence of post-MI VSD has decreased significantly with the advancement of early reperfusion therapy such as primary percutaneous coronary interventions, the clinical outcomes of post-MI VSD remain challenging. Since the timing of defect closure significantly influences survival, the treatment involves two strategies. Firstly, if possible, hemodynamic stabilization through medical therapy and MCS should be pursued until the fragile myocardium becomes stable enough. The goal is to provide a delay of at least 4 to 7 days to allow time for definitive therapy and significantly increase the chances of survival. Secondly, surgery is the gold standard for definitive treatment, however, the mortality rate still remains high. Recently, percutaneous defect closure treatment has shown comparable outcomes to surgery and is emerging as an alternative treatment. To the best of our knowledge, there is currently no ongoing randomized controlled trial related to the treatment of post-infarction VSD. Additionally, dedicated percutaneous closure devices for VSD have identified areas for improvement. Consequently, there is a crucial need for advancements in both surgical and percutaneous treatments to achieve higher clinical success. Further investigations are needed to confirm the clinical efficacy and safety of post-MI VSD treatment.

Kim Seok Hyun has acquired MD. degree at the age of 25 years from Kosin University Medical College, Korea. He is working in the department of cardiology at Pusan National University Yangsan Hospital, Korea. He has a few publications. He has been serving as an assistant professor.