Management of post‐myocardial infarction ventricular septal defects: A critical assessment

Abstract

Background: Post-myocardial infarction (MI) ventricular septal defects (PIVSD) are an uncommon but life-threatening complication of acute MI. Although surgical closure has been the standard of care, mortality, and recurrence of VSD remain high even after emergent surgery. Transcatheter VSD closure (TCC) devices have become an alternative or adjunct to surgical closure.Methods: Online database search was performed for studies that included adults with PIVSD who underwent medical treatment (MT) alone, surgical closure (SC) (early or late), and TCC (early, late, or for post-surgical residual VSD).Results: Twenty-six studies were included with a total of 737 patients who underwent either MT (N = 100), SC (early (n = 167), late (n = 100)), and TCC (early (n = 176), late (n = 115), or post-surgical residual VSD (n = 79)). The 30-day mortality among MT group was 92 ± 6.3%, among SC was 61 ± 22.5% (early 56 ± 23%, late 41 ± 30%), and for all TCC patients was 33 ± 24% (early 54 ± 32.7%, late 16 ± 26%), and TCC for post-surgical residual VSD 11 ± 34.9%. The mortality among overall SC, overall TCC and early TCC groups was significantly lower as compared with the MT (P < 0.001 for all comparisons).The overall mortality among all TCC, and late TCC groups was significantly lower when compared with the late SC (P < 0.0001, P < 0.0001, respectively). Conclusion: Closure of PIVSD decreases mortality as compared with MT alone and should be attempted as early as possible after diagnosis. Selection of TCC versus SC should be based on factors including complexity of the defect, availability of closure devices, expertise of the operator, and clinical condition of patient. K E Y W O R D S closure device, management, post-infarction VSD, transcatheter

Repair of ischemic ventricular septal defect with and without coronary artery bypass grafting

“…Maltais et al suggest that utilizing TCC for defects larger than 15 mm puts the patient at risk for device embolization or recurrent VSD 13 . Omar et al 14 recently found overall mortality was lower in the TCC group than the surgery group. However, the authors emphasize that either TCC or surgery are superior to medical therapy alone.…”

A Rare Complication of Myocardial Infarction: Ventricular Septal Defect

“…Treatment of post-MI VSD is challenging. The timing of intervention and the treatment approach continues to be an area of debate, depending on the type and size of the defect, clinical condition of the patient, and technical expertise [8][9][10]. Surgical management has been the standard treatment.…”

Adult Ventricular Septal Defect Repair Using a Robotic Totally Endoscopic Approach: A Case Report

“…Congenital VSDs are less common in adults due to spontaneous closure in most cases, however, VSDs can also be acquired from acute myocardial infarction or following surgical or interventional procedures in the heart. [4][5][6] Clinical presentation of VSDs is dependent upon their size and shunt severity. Indications for VSD closure include hemodynamically significant shunt, significant or worsening aortic regurgitation, and history of endocarditis.…”