Experiences with surgical treatment of ventricle septal defect as a post infarction complication

Coskun, Kasim Oguz; Coskun, Sinan Tolga; Popov, Aron Frederik; Hinz, José; Schmitto, Jan D.; Bockhorst, Kerstin; Stich, Kathrin; Köerfer, Reiner

doi:10.1186/1749-8090-4-3

Cited by 67 publications

(88 citation statements)

References 20 publications

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“…After an initial large study by Landzberg and Lock, 27 Holzer and colleagues 17 reported the immediate and 18 discussed the morbidity and death associated with surgical repair of post-MI VSDs. In their judgment, the impetus behind the development of percutaneous methods was the general reluctance of surgeons to attempt repeat surgical repair of post-MI VSDs.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Repair of Post-Myocardial Infarction Ventricular Septal Defect: Current Approaches and Future Perspectives

Baldasare¹,

Polyakov²,

Laub³

et al. 2014

Texas Heart Institute Journal

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Post-myocardial infarction ventricular septal defect is a devastating complication of STelevation myocardial infarction. Although surgical intervention isT he occurrence of a ventricular septal defect (VSD) after a myocardial infarction (MI) is an infrequent but serious sequela, which usually occurs within the first week.1 In the years before reperfusion became available, the incidence of VSD after an MI was between 1% and 2%, with an in-hospital mortality rate of 45% with surgery, and 90% with medical management alone.1-4 After the introduction of reperfusion therapy, the rate of post-MI VSD decreased to 0.2% to 0.34%. 4,5 However, mortality rates remain high after surgical intervention, ranging from 20% to 87%, depending on severity in the individual patient and on length of follow-up. 5-11Because surgery offers a better outcome than medical management alone, immediate surgical intervention is now a class I recommendation for post-MI VSD. 12,13 However, early surgical repair can be difficult because of the soft and friable tissue surrounding the area of infarction and the possibility of VSD expansion.14-16 In addition, a residual shunt persists in 10% to 37% of patients despite surgical repair; 11% of those residual defects need further surgical procedures. 7 An approach that would enable immediate hemodynamic stabilization and closure of the defect is desirable. Although transcatheter closure of a post-MI VSD is relatively new, investigators have shown that this procedure is well suited for treating residual shunts after surgical closure and for stabilizing critically ill patients as a bridge to future surgery. [17][18][19][20][21][22][23] We report our experience with 2 cases of the percutaneous closure of post-MI VSDs, which illustrate these principles. Case Reports Patient 1Transcatheter Closure of Recurrent Shunt after Surgical Repair. A 65-year-old man presented at our institution's emergency department with chest pain and shortness of breath. On physical examination, the patient exhibited signs of congestive heart failure, together with a grade 3/6 harsh holosystolic murmur. The patient was hypotensive, his cardiac enzymes were elevated, and electrocardiographic findings showed ST-elevation in the anterior leads. An echocardiogram revealed a VSD, an akinetic anterior wall, and a hyperdynamic posterior wall. Cardiac catheterization showed critical left main and multivessel coronary artery disease. The patient's pulmonary artery (PA) pressure was 42/22 mmHg, there was an oxygen elevation in the right ventricle (RV), and his PA oxygen saturation was 79%. The Qp/Qs was 2.2:1.The patient underwent successful coronary artery bypass grafting (CABG), together with Dacron-graft repair of the VSD. One week postoperatively, he developed increasing dyspnea and had a recurrent holosystolic murmur. He was found on echocardiography to have a residual VSD (Fig. 1). Repeat angiography showed 2 defects,

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Section: Discussionmentioning

confidence: 99%

“…17,18,24 Recurrence of a VSD occurs in 5% to 20% of surgical repair cases. [25][26][27] The considerable advantage of a percutaneous approach to repeat VSD repair is that the patient does not undergo a 2nd surgery.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Repair of Post-Myocardial Infarction Ventricular Septal Defect: Current Approaches and Future Perspectives

Baldasare¹,

Polyakov²,

Laub³

et al. 2014

Texas Heart Institute Journal

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“…4 This introduces a significant selection bias into surgical series, artificially inflating survival rates. [5][6][7][8] The advent of the Amplatzer family of ventricular septal defect (VSD) closure devices offers a potentially attractive alternative to surgical repair with multiple device implants possible if required ( Figure 1A). A few series of selected cases exist, with good results reported, [9][10][11] but there are no large series with early as well as delayed intervention.…”

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confidence: 99%

Percutaneous Closure of Postinfarction Ventricular Septal Defect

et al. 2014

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Background-Postinfarction ventricular septal defect carries a grim prognosis. Surgical repair offers reasonable outcomes in patients who survive a healing phase. Percutaneous device implantation represents a potentially attractive early alternative. Methods and Results-Postinfarction ventricular septal defect closure was attempted in 53 patients from 11 centers (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012); aged 72±11 years; 42% female). Nineteen percent had previous surgical closure. Myocardial infarction was anterior (66%) or inferior (34%). Time from myocardial infarction to closure procedure was 13 (first and third quartiles, 5-54) days. Devices were successfully implanted in 89% of patients. Major immediate complications included procedural death (3.8%) and emergency cardiac surgery (7.5%). Immediate shunt reduction was graded as complete (23%), partial (62%), or none (15%). Median length of stay after the procedure was 5.0 (2.0-9.0) days. Fifty-eight percent survived to discharge and were followed up for 395 (63-1522) days, during which time 4 additional patients died (7.5%).

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“…Due to its location, the posterior VSD is much more difficult to access surgically than the socalled anterior VSD located in the anterior part of the septum. Technical difficulties are the most probable cause of the slightly higher mortality among patients with posterior VSD, as compared to anterior VSD; therefore the search for new solutions in treating this life-threatening postinfarction complication is ongoing [4].…”

Section: Discussionmentioning

confidence: 99%

“…Introducing various new methods of early reperfusion of the heart area affected by the infarction (such as thrombolysis or percutaneous coronary procedures) allowed for the reduction of the incidence of this life-threatening complication: from 1-2% to 0.2% of acute myocardial infarctions [1,2]. Although cardiac surgeons have several techniques for repairing postinfarction VSDs at their disposal, mortality for these procedures is still high (20-50%) and remains unsatisfactory [3,4]. The method which is currently used most often is the method introduced by David [5]: it employs an endocardial patch to repair the defect and protect the fragment of the ventricular septum weakened by ischemia (an exclusion technique).…”

Section: Introductionmentioning

confidence: 99%

Repair of a postinfarction ventricular septal defect through the aortic opening – a

Tułecki¹,

Mizerski²,

Bródka³

2013

kitp

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StreszczenieOperacja pozawałowego ubytku w przegrodzie międzykomoro-wej umiejscowionego w tylno-przypodstawnej części przegrody należy do najbardziej wymagających zabiegów kardiochirurgicznych. W prezentowanym przypadku 63-letniego chorego zastosowano technikę dostępu przez ujście aortalne, zaadaptowaną z chirurgii wad wrodzonych serca. Opisana metoda może być korzystną dla pacjenta alternatywą w stosunku do klasycznego dostępu przez tylną wentrikulotomię. Słowa kluczowe: pozawałowy ubytek w przegrodzie międzyko-morowej, mechaniczne powikłania zawału serca, zawał serca. Kardiochirurgia i Torakochirurgia Polska 2013; 10 (2) 154 Case reports AbstractRepairing postinfarction ventricular septal defects located in the posterobasal part of the septum is one of the most demanding procedures in cardiac surgery. In the presented case of a 63-year-old patient, an approach through the aortic valve opening was applied. The method was adopted from the field of congenital heart surgery. The presented technique may be a good alternative to the widely used approach employing posterior ventriculotomy.

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Experiences with surgical treatment of ventricle septal defect as a post infarction complication

Cited by 67 publications

References 20 publications

Percutaneous Repair of Post-Myocardial Infarction Ventricular Septal Defect: Current Approaches and Future Perspectives

Percutaneous Repair of Post-Myocardial Infarction Ventricular Septal Defect: Current Approaches and Future Perspectives

Percutaneous Closure of Postinfarction Ventricular Septal Defect

Repair of a postinfarction ventricular septal defect through the aortic opening – a

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