Postinfarction Ventricular Septal Defect

Heart Drug, 2001

Recognition and treatment of patients with ventricular septal rupture following infarction have improved over the past 25 years to the extent that survival with good long-term palliation is achieved in the majority of patients treated surgically for this catastrophic complication of acute myocardial infarction. The small minority of patients who, by the process of selection, are seen for surgical correction of septal rupture several weeks after infarction routinely have repair of the septal defect with an operative risk of less than 10%. With increasingly early diagnosis of septal rupture, the majority of patients are seen for consideration of surgical repair often within hours after septal rupture. Most such patients seen early after septal rupture exhibit cardiogenic shock. Refinement of operative techniques both for suture repair of freshly infarcted myocardium and for repair of defects in different anatomical locations has markedly improved survival in these critically ill patients. Deferral of operation for the patient in cardiogenic shock after septal rupture represents a failed therapeutic strategy. Conversely, emergency operation for the patient with septal rupture and cardiogenic shock has markedly improved survival in this high-risk group. Prolonged intraaortic balloon pump support and deferred operation should be reserved for the uncommon patient who, because of delayed diagnosis or referral, is seen in an advanced stage of multisystem failure in which the risks of early operative intervention involve the function of organs other than the heart. History Ventricular septal rupture following infarction is an uncommon but serious complication of acute myocardial infarction (MI) and occurs less frequently than postinfarction left ventricular free wall rupture [l]. Latham [2] is credited with one of the first descriptions of this entity in his lectures on the heart published in 1845. In this description, he made no association between postinfarction ventricular septal defect (VSD) and coronary artery thrombosis. One of the first antemortem diagnoses of postinfarction VSD was made by Brunn [3] in 1923. Sager (41 in 1934 established specific clinical criteria for diagnosis and stressed the association of postinfarction

European Journal of Cardio-Thoracic Surgery, 2005

Objectives: Ventricular septal rupture is a rare but feared complication after acute myocardial infarction. Most reports about outcome after surgical treatment are single center experiences. We investigated the results after surgical repair in all patients in Sweden during a 7-year period. Methods: All patients undergoing surgical repair 1992-1998 were identified with the aid of the Swedish Heart Surgery Registry. The patients (nZ189, 63% men, mean age 69G8 years) were operated at 10 different centers. Pre-and peri-operative variables were collected from the Registry and individual patient charts. Mortality was calculated and a Cox proportional hazards regression model was used to identify independent predictors for early and late mortality. Mean follow-up was 2.4 years. Results: Seventy-seven of the 189 patients died within 30 days (41%). Urgent repair (Risk Ratio 4.2 (2.0-8.9), P!0.001) and posterior rupture (RR 2.1 (1.3-3.4), PZ0.002) were independent predictors of 30-day mortality. Total cumulative survival (Kaplan-Meyer) was 38% at 5 years. For patients that survived the first 30 days (nZ112), 5 year cumulative survival was 67%. Independent predictors for mortality after 30 days were number of concomitant coronary anastomoses (RR 1.5 (1.2-2.0), PZ0.001), residual postoperative shunt (RR 2.7 (1.4-5.4), PZ0.004) and postoperative dialysis (RR 3.4 (1.5-7.5), PZ0.003). Conclusions: Early mortality after surgical repair of post infarction septal rupture is still considerable. Early repair and posterior rupture are predictors of early mortality. Long-term survival in patients surviving the immediate postoperative period is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt.

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.

Journal of the Hong Kong College of Cardiology

Background: Early surgery is indicated for ventricular septal rupture (VSR) that develops after myocardial infarction (MI). Surgical repair carries a high mortality. The purpose of this study was to find out the in hospital outcome of the surgical repair of this complication at a tertiary care high volume centre. Methods and Results: A retrospective descriptive study was done by checking the hospital record of all those patients who had undergone surgical repair of post myocardial infarction ventricular septal rupture from January 2008 to August 2014. The hospital ethical committee gave permission for the study. All the patients underwent identical surgical procedure for the repair of septal rupture. Perioperative variables were recorded and descriptive statistics obtained. A total of 40 such patients were identified including 24 (60%) male and 16 (40%) female patients with a mean age of 55.4±10.7 years. Intra-aortic balloon pump was used in 27 (62.5%) patients preoperatively. Nine out of 40 patients were operated within 2 weeks of the occurrence of VSR. While 23 (57.5%) were operated after the 3 weeks of VSR. Six out of 9 patients died who were operated within 2 weeks. One out of 23 patients died who presented after 3 weeks duration after post MI VSR. Coclusion: Still a large number of patients suffer from post MI VSR in our setup. Surgical treatment carries high mortality especially those operated within first week. Patch repair of the ventricular septal is an acceptable treatment strategy for both anterior and posterior located septal ruptures.

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.

Acta Cardiologica, 2005

Twenty-two patients had ventricular septal rupture complicating acute myocardial infarction. Sixteen of the 22 patients underwent surgical repair. The clinical findings, catheterization data, and operative results suggest that closure of the rupture should be delayed when possible from three to six weeks after the infarction to allow firm fibrous healing of the region. When surgery is thus delayed, the operative risks are smaller and the long-term results are good.

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...

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 ...

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.

Kardiologia polska, 2008

Post-infarction ventricular septal defects (VSD) are rare (1-2%) but often fatal complications of acute myocardial infarction. These post infarction defects require urgent surgical treatment. We report a case unique in being a late presentation of post MI multiple VSDs. The patient survived surgery and a stormy post repair course with an excellent final outcome.