Evolution of echocardiographic modalities in detection of postmyocardial infarction ventricular septal defect and papillary muscle rupture: Study of 62 patients

Kishon, Yehezkiel; Iqbal, Amjad; Oh, Jae K.; Gersh, Bernard J.; Freeman, William K.; Seward, James B.; Tajik, A. Jamil

doi:10.1016/0002-8703(93)90417-8

Cited by 31 publications

(12 citation statements)

References 57 publications

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“…14 The diagnosis of severe MR complicating MI was established preoperatively by color-flow imaging and/or by left ventricular angiography and during surgery by direct observation in all patients. Diagnosis of ischemic MR resulting from PMR used standard echocardiographic criteria 15,16 and was confirmed in all patients during MR surgery at our institution on the basis of direct visualization of lesions. Mitral valve repair (MRep) or replacement (MVR) was performed according to the surgeon's assessment of the lesions.…”

Section: Study Design and Settingmentioning

confidence: 99%

Clinical Outcome After Surgical Correction of Mitral Regurgitation Due to Papillary Muscle Rupture

et al. 2008

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Background-Papillary muscle rupture (PMR) is an infrequent but catastrophic complication of acute myocardial infarction (MI). Although always considered, surgical treatment is often denied because of high operative mortality. Moreover, the effects of surgery for PMR on long-term outcome, particularly compared with expected outcome after MI, are undefined. Methods and Results-Fifty-four consecutive patients (age, 70Ϯ8 years; 74% male) underwent mitral surgery for post-MI PMR from January 1980 through December 2000. Severe presentation (cardiogenic shock, pulmonary edema, or cardiac arrest) was noted in 91% preoperatively. Performance of coronary artery bypass graft was associated with lower operative mortality (odds ratio, 0.18; 95% CI, 0.04 to 0.83; Pϭ0.011), whereas there was a trend for lower mortality after surgery after 1990 (odds ratio, 0.28; 95% CI, 0.06 to 1.3). Thus, operative mortality (overall, 18.5%) decreased from 67% up to 1990 without coronary artery bypass graft to 8.7% after 1990 with coronary artery bypass graft. Overall 5-year survival was 65Ϯ7%, and survival free of congestive heart failure was 52Ϯ7%. Five-year survival of 30-day operative survivors was 79Ϯ4%, identical (Pϭ0.24) to that of matched controls with MI (similar age, sex, ejection fraction, MI location, and MI year). Survival free of congestive heart failure was similar in PMR cases and MI controls (10-year survival, 28Ϯ8% versus 36Ϯ6%; Pϭ0.46). Conclusions-Surgery for post-MI PMR involves a notable operative mortality, but there are recent trends for lower operative risk, particularly with associated coronary artery bypass graft. Long term after surgery, outcome is restored to that of similar MI without PMR. These encouraging observations emphasize the importance of prompt diagnosis and aggressive therapeutic approach for patients incurring PMR after MI. (Circulation. 2008;118:1528-1534.)

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Section: Study Design and Settingmentioning

confidence: 99%

Clinical Outcome After Surgical Correction of Mitral Regurgitation Due to Papillary Muscle Rupture

et al. 2008

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“…Transthoracic echocardiography (TTE) remains the cornerstone of the non-invasive assessment of PI-VSD (Kishon, 1993). TTE is indicated in any patient who presents with evidence of acutely impaired ventricular function or in unexplained hemodynamic deterioration suggests a mechanical complication following an acute myocardial infarction (Buda, 1991).…”

Section: Echocardiographymentioning

confidence: 99%

Post Myocardial Infarction Ventricular Septal Defect

Firstenberg¹,

Rousseau²

2012

Front Lines of Thoracic Surgery

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Front Lines of Thoracic Surgery 30 weeks after their initial acute event. It was these experiences that set the foundation for the belief that operative management should be delayed as long as possible to allow for scarring of the necrotic myocardium to provide for a more stable repair. As experiences grew -in terms of the initial diagnosis and surgical management -early repair was advocated, particularly in patients who were stable before hemodynamic deterioration and subsequent end-organ failure. Clinical presentationThe incidence of PI-VSD has decreased considerably over the years with advances in myocardial reperfusion strategies. Historically, up to 5% of all myocardial infractions were associated with mechanical complications such free-wall rupture, papillary muscle rupture, and PI-VSD (Agnihotri, 2008). With current treatment algorithms that advocate early and aggressive attempts at revascularization of the acute ischemic myocardial -such as thrombolytic therapy, early percutanous interventions with coronary stenting (PCI), and, less frequently, emergent coronary artery bypass surgery (CABG) -the overall incidence has dropped significantly. Large multi-centers studies evaluating the pathophysiologies of acute myocardial infarctions have shown a current incidence of approximately 0.2% of all AMI. With delays in therapies, or late clinical presentation, and the resulting increase in myocardial damage, this incidence increases up to 2%. Despite the relatively low risk of developing a PI-VSD, it account for a disproportionally high risk of mortality. Over 5% of all early deaths after AMI are attributed directly to the pathophysiologic complications of PI-VSD (Poulsen, 2008). The timing of the development of a PI-VSD can be quite variable with the average time to clinical presentation is between 2 and 4 days, however presentation can be as few as a few hours after AMI or as long as several weeks. Patient risk factors include gender, with men at a greater risk than women (3:2 ratio), increasing age, and current smoking history. The mean age of presentation in GUSTO was 62.5 years and ranged from 44 to 81 years (Crenshaw, 2000).

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“…Color Doppler mapping allows rapid and reliable localization of the VSD site, including small VSDs with long serpiginous tracts and multiple VSDs, with sensitivity of up to 90% [9]. In addition, measurement of the color jet width at the VSD site has been shown to correlate with the pulmonic to systemic fl ow ratio and the true anatomic defect size, as determined during surgery or autopsy [10].…”

Section: Vsdmentioning

confidence: 99%

Role of echocardiography in acute myocardial infarction

Sia¹,

O’Meara²,

Ducharme

2008

Curr Heart Fail Rep

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Echocardiography is a valuable tool in diagnosing acute coronary syndrome in patients presenting with chest pain in the emergency department. After acute myocardial infarction (MI), echocardiography provides substantial information regarding risk stratification, hemodynamic assessment, detection of mechanical complications related to acute MI, and long-term prognosis. It also helps in guiding therapy in patients after MI. However, it provides limited value in less than 10% of patients because of poor image quality. Contrast agent can and should be used to improve the accuracy of echocardiographic assessment.

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Evolution of echocardiographic modalities in detection of postmyocardial infarction ventricular septal defect and papillary muscle rupture: Study of 62 patients

Cited by 31 publications

References 57 publications

Clinical Outcome After Surgical Correction of Mitral Regurgitation Due to Papillary Muscle Rupture

Clinical Outcome After Surgical Correction of Mitral Regurgitation Due to Papillary Muscle Rupture

Post Myocardial Infarction Ventricular Septal Defect

Role of echocardiography in acute myocardial infarction

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