65 years old male presented with Acute Anterior wall MI windowperiod- 72hrs NIDDM Hypertensive Presented with Cardiogenic shock ECHO showsapical VSD EF 35% There was sever TR and PAH VSD was showing left to rightshunt with PAH RWMA in Anterior territory. 
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NIDDM Hypertensive Presented with Cardiogenic shock ECHO shows apical VSD EF 35% There was sever TR and PAH VSD was showing left to right shunt with PAH RWMA in Anterior territory.

Angiogram reveals mid LAD 100%, out of window period
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Angiogram reveals mid LAD 100%, out of window period. IABP was inserted and approached through 6F femoral and 8F internaljugular sheaths. LV entered & VSD crossed and looped in the pulmonary arterysneared through VSD defect into the pulmonary artery, Then ASD device Amplatz 14mmdelivered through 8F sheath, Finally the ASD device was released, and there was noresidual shunt on ECHO, The Patient was stabilized in CCU & IABP was slowlyweaned off in next 4-5 days and discharge ECHO shows no residual shunt andstable hemodynamics
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We conclude from this study that VSD device closure insetting ofPost MI is feasible and can be successful as an alternative to surgery. InExtreme cases of hemodynamic instability and shock patient can be taken on MCSlike ECMO. In our case we stabilized the patient with IABP support and an NIVsupport. The most important risk factor for mortality is presence ofcardiogenic shock and closure in acute phase. We did our case at 72 hrs. andpatient was in cardiogenic shock. Percutaneous closure is an option for patients whose comorbiditiespreclude surgical repair and whose septal anatomy is favourable to deviceplacement.