Delayed Ventricular Septal Rupture Repair on Patient Outcomes After Myocardial Infarction: A Systematic Review

Rashid, Haroon; Kumar, Kantash; Ullah, Asif; Kamin, Matiullah; Shafique, Muhammad; Elahi, Azaan; Najam, Ali; Zaidi, Syed Muhammad Jawad; Asad, Muhammad Usman; Mahmoodi, Amin; Malik, Jahanzeb

doi:10.1016/j.cpcardiol.2022.101521

Cited by 6 publications

(2 citation statements)

References 20 publications

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“…Surgical repair of anterior VSD usually involves making an incision in the left ventricular apex, fitting a pericardial patch, and suturing it to non-infarcted areas. The timing of surgery is a topic of contention, with the American College of Cardiology and the American Heart Association guidelines recommending early surgical intervention; in contrast, several studies have demonstrated improved outcomes with delayed surgery [ 5 ] . However, some reports of improved outcomes with delayed surgery may have an inherent bias as patients with unfavourable presentations may be excluded due to early mortality.…”

Section: Discussionmentioning

confidence: 99%

Delayed closure of ventricular septal defect with prolonged mechanical support

Shehzad,

Ahmad

et al. 2024

European Journal of Case Reports in Internal Medicine

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Introduction: Ventricular septal defect (VSD) is a severe complication following acute myocardial infarction (MI) resulting from mechanical disruption of the interventricular septum due to extensive myocardial necrosis. Despite advances in management, the mortality rate approaches 50%. We report a case of a 58-year-old male with VSD following MI who was successfully treated with a delayed surgical approach after haemodynamic support using Impella. Case description: A 58-year-old man with type 2 diabetes mellitus and hypertension presented with three days of chest pain. Testing revealed late presenting acute anterior ischaemic infarction and left-to-right shunt in the apical ventricular septum. Urgent cardiac catheterisation showed near-total occlusion of the left anterior descending artery. An Impella CP® was placed before angioplasty with a drug-eluting stent to optimise haemodynamics. After a multidisciplinary discussion, the Impella CP® was upgraded to Impella 5.5®, and surgery was delayed allowing for scar formation. The patient remained in the intensive care unit, where he underwent physical therapy, showing improvements in exercise tolerance by the time of surgery. He underwent a left ventriculotomy with a successful repair via an endocardial patch 28 days after initial presentation. Post-operative recovery was uneventful, with the patient discharged five days later, reporting no physical limitations one month post-discharge. Conclusion: The successful management of VSD post-MI relies on interdisciplinary collaboration, careful timing of surgical intervention and the strategic use of mechanical support devices such as the Impella. This case highlights the potential for favourable outcomes when tailored treatment approaches are employed.

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Section: Discussionmentioning

confidence: 99%

Delayed closure of ventricular septal defect with prolonged mechanical support

Shehzad,

Ahmad

et al. 2024

European Journal of Case Reports in Internal Medicine

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“…Owing to the fragility of the necrotic myocardium in the acute phase of MI, the mortality and re-rupture rates are high after early repair (5). Although the optimal repair time has not been determined, prolonging the preoperative waiting time can improve the success rate of repair in patients with relatively stable hemodynamics (6)(7)(8). Cardiogenic shock (CS) is a common complication of VSR, and it is considered to be an important cause of poor prognosis in patients with VSR (7,9,10).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for immediate and delayed cardiogenic shock in patients with ventricular septal rupture after myocardial infarction

Wang,

Zhang,

Xiao

et al. 2023

Front. Cardiovasc. Med.

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BackgroundVentricular septal rupture (VSR) is a serious complication occurring after myocardial infarction (MI). Cardiogenic shock (CS) is a common complication of VSR and an important factor affecting its prognosis. CS can occur in either an immediate or delayed manner after VSR; however, studies on the risk factors associated with immediate or delayed CS are scarce.MethodsWe retrospectively studied patients diagnosed with VSR after MI and admitted to the West China Hospital between September 2009 and August 2023. Demographic data, medical history, physical examination results, electrocardiograms, and echocardiographic and hematological data were extracted from electronic medical records or archived records. CS was defined as hypotension (<90 mmHg) and/or the requirement for catecholamines, pulmonary congestion, and signs of end-organ failure. The CS onset time was defined as the time at which catecholamines were initiated.ResultsA total of 88 patients with VSR after MI, including 49 males (55.7%), were enrolled. The average age was 70.2 years. Of these patients, 32 (36.4%) who already had CS at the time of VSR discovery were defined as immediate CS, and 28 (31.8%) who developed CS within 2 weeks after VSR discovery were defined as delayed CS. A smaller left ventricular end-diastolic diameter (LVEDD) and VSR discovered after admission were independent risk factors for immediate CS. Elevated heart rate and higher levels of creatine kinase-MB isoenzyme on admission were independent risk factors for delayed CS in patients without immediate CS after VSR.ConclusionsThe occurrence of CS in patients with VSR after MI has an evident time course. Thus, an early identification of patients at risk of immediate or delayed CS and optimization of treatment procedures may help improve the prognosis.

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