Percutaneous closure of iatrogenic right ventricular free-wall perforation using a Konar-MF ventricular septal defect occluder: a case report

Right ventricular (RV) perforation during pericardiocentesis is a rare, life-threatening complication. Surgical repair is the traditional management but carries a prohibitive risk in elderly patients with severe left ventricular (LV) dysfunction.

A 65-year-old male with diabetes, hypertension, prior cerebrovascular accident (2021), and chronic kidney disease presented with acute anterior wall myocardial infarction, treated with thrombolysis and subsequent percutaneous coronary intervention (PCI) to the left anterior descending coronary artery (LAD) and right coronary artery (RCA) under temporary pacemaker (TPI) support for bradycardia. Pre-PCI echocardiography showed severe LV dysfunction [ejection fraction (EF) 20%–25%] and mild pericardial effusion. He was stable after PCI, but 1 week later, he developed tamponade. Pericardiocentesis revealed RV puncture confirmed by a bubble contrast study. Definitive closure was achieved percutaneously with a Konar-MF 6/4 mm ventricular septal defect occluder, with successful sealing and clinical recovery.

This case emphasizes the feasibility of percutaneous device closure as a lifesaving alternative to surgery in iatrogenic RV rupture. Compared with prior reports using Amplatzer occluders, our experience highlights the advantages of the Konar-MF device, including flexibility, low delivery profile, and secure anchoring across thin RV myocardium.