Surgical Treatment of Postinfarction Ventricular Septal Defects

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.

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.

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.

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.

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

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...

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.

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...

Vojnosanitetski pregled, 2015

Acquired ventricular septal defect (VSD) is uncommon, but serious mechanical complication of acute myocardial infarction with poor outcome and high mortality rate in surgically or medically treated patients. We report a 58-year-old male patient admitted to our hospital six days following acute inferior myocardial infarction complicated by ventricular septal rupture with signs of heart failure. Coronary angiography revealed 3-vessel disease, with proximally occluded dominant right coronary artery. Transthoracic echo exam revealed aneurysm of a very thin inferior septum and the basal portion of the inferior left ventricular wall, with septal wall rupture. One of the VSD dimensions was 15 mm and left- to right shunt was calculated 2:1. Since the patient was at too high risk for surgical closure, transcatheter closure of VSD was chosen as a better option. Under short intravenous sedation, 24 mm Am- platzer device was implanted percutaneously with transesophageal echo guidance. The post-...