Post-infarction ventricular septal defect--a case report

Catheterization and Cardiovascular Interventions, 2001

The incidence of Ventricular septal defect as a complication of acute myocardial infarction is 1-2%. The present study is a retrospective analysis of the in-hospital course, management and outcome of patients who developed post-infarction VSD.

Indian Journal of Thoracic and Cardiovascular Surgery, 2004

The incidence of Ventricular septal defect as a complication of acute myocardial infarction is 1-2%. The present study is a retrospective analysis of the in-hospital course, management and outcome of patients who developed post-infarction VSD.

Journal of interventional cardiology, 2018

Post-myocardial infarction (MI) ventricular septal defects (PIVSD) are an uncommon but life-threatening complication of acute MI. Although surgical closure has been the standard of care, mortality, and recurrence of VSD remain high even after emergent surgery. Transcatheter VSD closure (TCC) devices have become an alternative or adjunct to surgical closure. Online database search was performed for studies that included adults with PIVSD who underwent medical treatment (MT) alone, surgical closure (SC) (early or late), and TCC (early, late, or for post-surgical residual VSD). Twenty-six studies were included with a total of 737 patients who underwent either MT (N = 100), SC (early (n = 167), late (n = 100)), and TCC (early (n = 176), late (n = 115), or post-surgical residual VSD (n = 79)). The 30-day mortality among MT group was 92 ± 6.3%, among SC was 61 ± 22.5% (early 56 ± 23%, late 41 ± 30%), and for all TCC patients was 33 ± 24% (early 54 ± 32.7%, late 16 ± 26%), and TCC for post...

2013

Acute myocardial infarction (AMI), despite advances in health care delivery systems, educa‐ tion, and primary prevention still remains a significant problem. Fortunately, with these ad‐ vances and early interventions, there has been a decline in the incidence of mechanical complications. Unfortunately, while becoming less common, when mechanical complica‐ tions occur and despite advances and evolving techniques in the surgical management of these problems, morbidity and mortality remain high. Post-myocardial infarction ventricu‐ lar septal rupture (PI-VSD) has challenged and intrigued clinicians for years. The timing of presentation can be quite variable, as they tend to occur in patients several days after their initial cardiovascular insult (acute PI-VSD) – and unfortunately, they can occur in patients who appear to otherwise be doing well. In addition, while less common, some patients might not present until weeks, if not longer, after their AMI with symptoms prompting a work-up ...

Circulation, 1965

A series of four patients who died following rupture of the ventricular septum due to myocardial infarction has been reported. One of these died of hemorrhage due to a defective clotting mechanism 8 hours after successful surgical repair. The 13 cases of surgical repair of postinfarction ventricular septal defect reported by other authors are reviewed. The time interval is important and preferably 3 to 6 months should elapse following myocardial infarction before surgery is undertaken. Surgery should be considered in every patient diagnosed as having an acute septal rupture following myocardial infarction who fails to respond to vigorous medical treatment.

Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē

Rupture of the ventricular septum complicates acute myocardial infarction in 0.2% of cases in the thrombolytic era. Ventricular septal defect (VSD) has a mortality of 90-95% in medically managed and 19-60% in surgically treated patients. A retrospective analysis was performed of 41 patients, 26 females (63.4%) and 15 males (36.6%), average age 67.5 ± 15 years, with post-infarction VSD who were treated in the VUL SK intensive cardiology unit between 1991 and 2007. Thirty-seven patients had hypertension (90.2%); anterior wall acute myocardial infarction (AMI) was found in 27 patients (68%). VSD was more frequent in women than in men (p=0.043). In 36 patients (87%) treatment was started 24 hours or later after the development of AMI symptoms. In 34 patients (83%) the rupture occurred during the first episode of AMI and in the majority of these (19 patients, 46.3%), preoperative coronary angiography demonstrated disease of only one coronary artery. During the first 10 days after the ons...

International Journal of Cardiology, 2006

... Conclusions. The surgical repair of post-infarction VSD entails a high operative mortality; different techniques were employed with similar results. ... with double patch repairs. Associated procedures were one mitral and one tricuspid valve replacement. ...

The Annals of Thoracic Surgery, 1979

Review of the literature since 1970 revealed more than 200 patients who had a ventricular septal defect following myocardial infarction and underwent operation. Pathogenesis and diagnosis are discussed. The primary therapy is operative repair, which is considered from the standpoint of approach, timing, technique, concomitant coronary artery bypass, mortality, and long-term survival. Operative mortality in those patients operated on less than 3 weeks following perforation remains high (40%) but when it is possible to wait 3 weeks, there is a marked decrease in mortality (6%). Several general principles have evolved for the care of these patients. (1) Operation should be deferred until 3 weeks after infarction if possible. (2) The intraaortic balloon allows preoperative evaluation of the patient with clinical hemodynamic deterioration in the early postinfarction period. (3) The incision should be placed through the infarct. (4) Associated coronary artery or mitral valve disease should be repaired as well.

Scholars Journal of Medical Case Reports

Introduction and aims: Post-myocardial infarction ventricular septal defect is a rare dreadful complication of myocardial infarction. It usually occurs between the 3rd and 7th day of the infarction. Several risk factors for its occurrence have been identified. The aim of our work is to discuss these different risk factors through clinical cases with a literature review. Material and methods: This is a retrospective study conducted from 2015 to 2021 including 18 consecutive patients with post-myocardial ventricular septal defect presented in either cardiac intensive care unit or cardiac surgery department of Mohammed V Military Teaching Hospital Rabat. All patients had at least a clinical examination, an electrocardiogram, and an echocardiogram showing ventricular septal defect. Surgery was performed at cardiac surgery department. Results: Mean age was 65.2± 26.4 years. There were more men than women in our study (17 males/1 female). Diabetes (55.6%) and smoking (55.6%) were the two ...

International Journal of Contemporary Medical Research [IJCMR], 2019

Introduction: Surgical approaches to closure of post myocardial infarction ventricular septal defect (PIVSD) are associated with high morbidity and mortality. Timing of intervention for its closure remains controversial. Several studies advocate early operative intervention, after diagnosis of PIVSD but these are associated with high mortality. However, the strategy of delayed closure around 14 to 20 days or higher has been advocated in certain subsets of patients who can be stabilized from cardiogenic shock (CS) with pharmacological means with or without temporary mechanical circulatory support (tMCS). This helps to allow tissue fibrosis around PIVSD which increases the chance of operative success. Results of 5 such patients in whom surgery was moderately delayed, and 2 in whom early operation were performed are reported in this paper. Material and methods: Between May 2012 to April 2016, 7 consecutive patients of PIVSD had operative closure under cardio pulmonary bypass in our hospital. 5 patients had diuretic and inotrope responsive CS and had delayed closure of PIVSD within 12 to 20 days, while 2 with severe CS, who were supported preoperatively with tMCS like intra aortic balloon pump (IABP), had early closure within 72 hours. Patient data of these seven subjects were retrospectively collected, and the current status of the survivors was ascertained by out patient follow up. Results: 4 of 5 patients from delayed surgery group with small PIVSD survived while 1 patient had early mortality due to severe right ventricular dysfunction post operatively resulting in LCOS. 1 patient out of the 2 early surgery group with a large PIVSD survived while the other patient with a small PIVSD and an extensive MI had early post operative mortality. 1 had from late surgery group had delayed mortality after 3 years. 4 patients are living at present. Conclusion: We advocate delayed elective repair of PIVSD, in patients with CS who responded to aggressive conservative management maintaining hemodynamic stability, to allow inflammatory state to subside. In those patients with severe CS, additional rescue therapy with temporary mechanical circulatory support is needed to prevent further deterioration of systemic perfusion. If the severe CS is due to high left to right shunt rather than infarct size, prognosis after repair of PIVSD is better than in patients with CS due to extensive myocardial damage.