Management issues during postinfarction ventricular septal defect and role of perioperative optimization: A case series

Khazi, Fayaz Mohammed; Al-Safadi, Faozi; Karaly, Yehia; Siddiqui, Nayyer R; Al-Zamkan, Bassil; Aljassim, Obaid

doi:10.4103/aca.aca_189_17

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…We suggest that a multidisciplinary team carefully weigh the risk and benefits of LV venting in patients supported with ECMO. 53,54 Emergency surgery is indicated for patients with cardiogenic shock and pulmonary edema refractory to mechanical circulatory support. Lower mortality is reported when surgery is delayed for a week after diagnosis, although selection and survival bias may explain these reported outcomes.…”

Section: Ventricular Septal Defectmentioning

confidence: 99%

Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association

Damluji¹,

Diepen²,

Katz³

et al. 2021

Circulation

221

171

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Over the past few decades, advances in pharmacological, catheter-based, and surgical reperfusion have improved outcomes for patients with acute myocardial infarctions. However, patients with large infarcts or those who do not receive timely revascularization remain at risk for mechanical complications of acute myocardial infarction. The most commonly encountered mechanical complications are acute mitral regurgitation secondary to papillary muscle rupture, ventricular septal defect, pseudoaneurysm, and free wall rupture; each complication is associated with a significant risk of morbidity, mortality, and hospital resource utilization. The care for patients with mechanical complications is complex and requires a multidisciplinary collaboration for prompt recognition, diagnosis, hemodynamic stabilization, and decision support to assist patients and families in the selection of definitive therapies or palliation. However, because of the relatively small number of high-quality studies that exist to guide clinical practice, there is significant variability in care that mainly depends on local expertise and available resources.

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Section: Ventricular Septal Defectmentioning

confidence: 99%

Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association

Damluji¹,

Diepen²,

Katz³

et al. 2021

Circulation

221

171

View full text Add to dashboard Cite

show abstract

“…Nonetheless, this strategy also carries the risk of rupture extension and death while waiting for surgery [ 8 ]. Preoperative optimization of the already poor cardiac function and hemodynamic status during the waiting periods is challenging [ 27 ]. MCSs utilization, either as a sole device or in combination, is often required.…”

Section: Discussionmentioning

confidence: 99%

Intra-aortic balloon pump still has a role in late-onset myocardial infarction complicated by ventricular septal rupture with intractable heart failure: a case report

Alsagaff,

Revianto,

Sembiring

et al. 2024

J Med Case Reports

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Background The current guidelines have discouraged the routine use of intra-aortic balloon pump (IABP) in cardiogenic shock complicating acute coronary syndrome (ACS). Since then, the trend of IABP utilization in ACS has been declining. Nevertheless, the guidelines still preserve the recommendation of IABP use in hemodynamic instability or cardiogenic shock caused by post myocardial infarction (MI) ventricular septal rupture (VSR). Case presentation A 46-years-old diabetic Southeast Asian female was referred from a peripheral facility with intractable heart failure despite treatment with vasoactive agents and diuretics for five days. The ECG suggested a recent anteroseptal myocardial infarction with normal high-sensitivity troponin-I value. The echocardiography detected a regional wall motion abnormality and a 10 mm wide ventricular septal defect. Invasive coronary angiography revealed a severe two-vessel coronary artery disease. We planned a delayed surgical strategy with preoperative optimization using IABP as a bridge to surgery. IABP implantation followed by significant hemodynamic improvement and rapid resolution of heart failure without any inotrope support. Afterwards, coronary artery bypass grafting (CABG) and VSR surgical repair were performed. We safely removed IABP on the third postoperative day with proper weaning and minimal vasoactive support. Conclusion We report a case where IABP still provided benefits for a patient with intractable heart failure caused by undetermined onset MI complicated by VSR. The use of IABP in such a case is in accordance with the recommendation of the current guidelines. Several studies showed that IABP use during preoperative optimization in the case of post-MI VSR was associated with survival benefits.

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“…This is match with our cases, as VSR in both patients occurred on 5 th day post AMI. Etiology of VSR is a total occlusion of the coronary arteries that supply interventricular septum, resulting in transmural myocardial infarction (full thickness infarction) [3,6,11] .…”

Section: Discussionmentioning

confidence: 99%

“…The gold standard for diagnosing VSR is those with sudden hemodynamic instability and suspicion of VSR. [2,6,11,17] Management of VSR requires rapid diagnosis, aggressive oxygenation and hemodynamic stabilization of the patient with medication, mechanical support and surgery [1,10] .…”

Section: Discussionmentioning

confidence: 99%

“…The outcome of surgery is strongly influenced by size of the rupture, hemodynamic status and patient's surgical risk. [8,10,11,15] In both of our patients, due to limited resources and other considerations, surgical therapy was planned 2 weeks after the onset of AMI. Prior to that, hemodynamic stabilization and treating acute heart failure with appropriate pharmacological therapy were carried out, so that surgical therapy gave optimal results for the patient.…”

Section: Discussionmentioning

confidence: 99%

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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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Management issues during postinfarction ventricular septal defect and role of perioperative optimization: A case series

Cited by 5 publications

References 25 publications

Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association

Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association

Intra-aortic balloon pump still has a role in late-onset myocardial infarction complicated by ventricular septal rupture with intractable heart failure: a case report

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

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