Delayed ventricular septal rupture complicating anterior wall myocardial infarction

Dulai, Rajdip; Hline, Aye; Javaid, Mahvesh Rana; Akhtar, Javed

doi:10.1136/bcr-2016-215523

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…Mechanical support systems such as IABP (intra-aortic balloon counter pulsation), ECMO (extracorporeal Membrane Oxygenation), LVAD (left ventricular assist device) can be used to assist bridging therapy before definitive therapy. [1,10,19] Definitive therapy for VSR patients is surgical closure/repair of the septum accompanied by CABG. Transcatheter closure of the septal defect can be an alternative therapy.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Septal Rupture (VSR) in Post-Acute Anterior Myocardial Infarction Patients : A Case Series

Kawilarang¹,

Hermawan²,

Hartono³

2022

CCJ

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Case Summary: We present 2 cases of post-STEMI VSR. They had anterior AMI without reperfusion therapy because of patient delay and limited resources. Thereafter apical VSR occurs on 5th day. VSR was suspected because of sudden hemodynamic deterioration and new holosystolic murmur (Grade III/VI) at left parasternal line of fourth-fifth ICS. Then it was confirmed by echocardiography. Both patients underwent hemodynamic stabilization while waiting for surgical therapy. Unfortunately, they deceased because of cardiogenic shock accompanied by other comorbidities. Discussion: VSR causes shunt from left to the right ventricle, which overloads the RV, leading to cardiogenic shock. The peak incidence of VSR in the first 24 hours or 3-5 days post-AMI. This fits both of our cases. VSR occurs in total coronary occlusion, which then causes coagulation necrosis in the ischemic area, characterized by neutrophils that trigger apoptosis and lytic enzymes, so that septum becomes thin, brittle then ruptures. VSR is most common in anterior AMI and the defect is at apical septum, as in our patients. Definitive therapy for VSR is surgical closure, but the best timing is still under debate. This article is expected to make us more aware of post-AMI VSR, so we can quickly diagnose and promptly treat the patients with multidisciplinary approach. This is very important to optimize patient’s outcomes even in limited resources area.

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Section: Discussionmentioning

confidence: 99%

Ventricular Septal Rupture (VSR) in Post-Acute Anterior Myocardial Infarction Patients : A Case Series

Kawilarang¹,

Hermawan²,

Hartono³

2022

CCJ

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“… 2 Instances of presentation beyond several weeks after the index AMI are exceedingly rare. 3 , 4 Patients may present with varying degrees of severity, encompassing mild hemodynamic instability in the early stages, which can swiftly escalate to cardiogenic shock if left unattended. The therapeutic approach entails surgical closure, achieved through either open thoracotomy combined with concurrent coronary artery bypass grafting (CABG) or transcatheter repair, the latter being employed for small defects or as a salvage intervention for defects inadequately addressed via surgical means.…”

Section: Introductionmentioning

confidence: 99%

Delayed Presentation of a Post-infarction Ventricular Septal Rupture

Ahmed,

Singh,

Bai

et al. 2024

Journal of Investigative Medicine High Impact Case Reports

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Ventricular septal rupture, a formidable complication of acute myocardial infarction (AMI), is linked to significant morbidity and mortality. The clinical manifestation typically involves pronounced hemodynamic compromise necessitating prompt surgical intervention. This report outlines the case of a 60-year-old male presenting with acute heart failure 3 weeks post a presumed AMI. On evaluation, a substantial ventricular septal defect with left-to-right shunt was observed. The patient, although hemodynamically stable with mild symptoms, underwent surgical closure of the defect and coronary artery bypass graft for multivessel coronary artery disease. This case contributes to the literature on the delayed presentation of post-myocardial infarction (MI) ventricular septal rupture, a scenario deviating from the anticipated severe hemodynamic instability given the timing of the MI and the extent of the septal defect.

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“…Apical defects are outcome of anterior infarction and inferior or lateral infarctions are more likely to result in basal defects at the point of junction of the septum and the posterior wall. 6 Ventricular septal rupture is a very dangerous complication of acute myocardial infarction causing mortality in 98% of cases and still there is a room for conducting more studies in Pakistan to understand the gravity of the situation. 7 Therefore this study will help whether early thrombolysis increases or decreases the mortality in such patients and will help in modifying our future clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Effect of early thrombolysis on the clinical outcome of ventricular septal rupture in patients with myocardial infarction

Waheed,

Ali,

Khan

et al. 2023

ijhs

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Background: Ventricular septal rupture is one of the most lethal complications of myocardial ischemia with timely treatment preventing the catastrophic results for the patients.1 Objective: To determine whether early thrombolysis’ in patients with VSR increases or decreases mortality and to assess the risk factors for development of VSR in patients with ST elevation MI. Materials and Methods: This cross-sectional study was done at Peshawar Institute of Cardiology after the approval of synopsis from ethical research committee of the institution bearing IRC/23/54 dated 28 September 2023. The sample size was 34 and method was non-probability convenient. The inclusion criteria were all those patients who had acute myocardial infarction and detectable VSR on ECHO. Data collection will be started after IRB approval. All patients admitted via ER to CCUs and diagnosed as cases of VSR through clinical exam and ECHO findings. Descriptive analysis was employed to find out the mean age and Chi Square test and Pearson Correlation was employed to compare the outcomes of the patients after receiving thrombolysis with a p value of less than 0.05 as significant.

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Delayed ventricular septal rupture complicating anterior wall myocardial infarction

Cited by 4 publications

References 10 publications

Ventricular Septal Rupture (VSR) in Post-Acute Anterior Myocardial Infarction Patients : A Case Series

Ventricular Septal Rupture (VSR) in Post-Acute Anterior Myocardial Infarction Patients : A Case Series

Delayed Presentation of a Post-infarction Ventricular Septal Rupture

Effect of early thrombolysis on the clinical outcome of ventricular septal rupture in patients with myocardial infarction

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