Postinfarction ventricular septal defect closure with Amplatzer occluders

Szkutnik, Małgorzata; Białkowski, Jacek; Kusa, Jacek; Banaszak, Paweł; Baranowski, J. M.; Gąsior, Mariusz; Chodór, Piotr; Zembala, Marian

doi:10.1016/s1010-7940(02)00812-6

Cited by 68 publications

(57 citation statements)

References 7 publications

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“…5,[17][18][19][20][21][22]24,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] Most such patients underwent VSD closure in the chronic or subacute phase, or experienced residual shunting after surgical patch closure. 5 This summary presents the results of a prospective series in which all patients with post-MI VSDs were treated in the acute setting, whether or not they were in severe cardiogenic shock.…”

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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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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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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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“…In a single centre Polish series of seven patients, procedural success was achieved in five, mostly using the Amplatzer atrial septal occluder. 11 There are a number of other publications that describe fewer patients treated with the Amplatzer VSD device. 3,12 The outcomes are difficult to compare with those of published surgical series given the small patient numbers and the patient selection bias present in all studies.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Closure of Post-Myocardial Infarction Ventricular Septal Defects: A Single Centre Experience

Ahmed

Ruygrok

Wilson

et al. 2008

Heart, Lung and Circulation

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“…Device closure is difficult while the margins of the septal rupture are soft [47]. It may provide a temporary hemodynamic relief and allows surgical closure when the infarcted myocardium has had time to fibrose [48].…”

Section: Catheter Therapymentioning

confidence: 99%

“Swiss-Cheese” Left Ventricle in Acute Myocardial Infarction—A Case Report

Muthiah¹

2017

CRCM

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Introduction: To present a rare occurrence of "Swiss-cheese" defects of left ventricle in acute myocardial infarction. Case Report: A 64-year-old male with persistent ST segment elevation in anterior and inferior leads developed sudden deterioration within 2 days after thrombolysis. Echocardiography revealed ventricular septal and LV (left ventricular) free wall ruptures at multiple sites with contractile dysfunction and the patient died suddenly, followed by an episode of ventricular tachycardia. Discussion: Myocardial rupture may complicate in 10% of acute myocardial infarctions and it is the second most common cause of in-hospital mortality next to pump failure. It is responsible for 15% of in-hospital deaths and 50% died within 5 days and 82% died within two weeks of index infarction. Conclusion: Aggressive early diagnosis and surgery may confer a survival rate as high as 75%. The prognosis is grave in patients presented with cardiogenic shock and multiorgan dysfunction; surgery is best avoided and supportive medical therapy may be adequate in such cases.

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Postinfarction ventricular septal defect closure with Amplatzer occluders

Abstract: Despite some technical problems, implantation of Amplatzer occluders, is an attractive option of treatment of patients with subacute PIVSD.

Cited by 68 publications

References 7 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 Post-Myocardial Infarction Ventricular Septal Defects: A Single Centre Experience

“Swiss-Cheese” Left Ventricle in Acute Myocardial Infarction—A Case Report

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