Risk factors and outcome analysis after surgical management of ventricular septal rupture complicating acute myocardial infarction: a retrospective analysis

Huang, Shuping; Huang, Su‐Cheng; Wang, Chih‐Hsien; Wu, I-Hui; Chi, Nai‐Hsin; Yu, Hsi‐Yu; Hsu, Ron‐Bin; Chang, Chung-I; Wang, Shoei‐Shen; Chen, Yih‐Sharng

doi:10.1186/s13019-015-0265-2

Cited by 43 publications

(47 citation statements)

References 27 publications

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“…Our experience suggests that V‐A ECMO successfully stabilizes patients with VSR and refractory CS ( Table ) who would not definitely be considered suitable candidates for surgical repair. Similar outcomes have recently been reported by other groups . Therefore, we suggest early V‐A ECMO initiation to be considered as a reasonable approach in patients who are haemodynamically unstable before contemplated surgery.…”

Section: Discussionsupporting

confidence: 88%

“…Moreover, published literature on this topic is limited to a small number of case reports and case series . Furthermore, different timing and choice of therapy in each case does not allow any meaningful analysis.…”

Section: Discussionmentioning

confidence: 99%

“…These patients have an unacceptably high mortality with an urgent/emergent surgery approach . A growing body of published data suggests increasing use of Veno‐Arterial Extracorporeal Membrane Oxygenation (V‐A ECMO) and other circulatory support devices in patients with VSR complicated by CS . Therefore we analysed our experience with an early ECMO approach in patients with postinfarction VSR complicated by cardiogenic shock.…”

Section: Introductionmentioning

confidence: 99%

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A rationale for early extracorporeal membrane oxygenation in patients with postinfarction ventricular septal rupture complicated by cardiogenic shock

Rob

Špunda

Lindner

et al. 2017

European J of Heart Fail

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Aims Ventricular septal rupture (VSR) became a rare mechanical complication of myocardial infarction in the era of percutaneous coronary interventions but is associated with extreme mortality in patients who present with cardiogenic shock (CS). Promising outcomes have been reported with the use of circulatory support allowing haemodynamic stabilization, followed by delayed repair. Therefore, we analysed our experience with an early use of Veno‐Arterial Extracorporeal Membrane Oxygenation (V‐A ECMO) for postinfarction VSR. Methods and results We conducted a retrospective search of institutional database for patients presenting with postinfarction VSR from January 2007 to June 2016. Data from 31 consecutive patients (mean age 69.5 ± 9.1 years) who were admitted to hospital were analysed. Seven out of 31 patients with VSR who were in refractory CS received V‐A ECMO support preoperatively. ECMO improved end‐organ perfusion with decreased lactate levels 24 hours after implantation (7.9 mmol/L vs. 1.6 mmol/L, p = 0.01), normalized arterial pH (7.25 vs. 7.40, p < 0.04), improved mean arterial pressure (64 mmHg vs. 83 mmHg, p < 0.01) and lowered heart rate (115/min vs. 68/min, p < 0.01). Mean duration of ECMO support was 12 days, 5 out of 7 patients underwent surgical repair, 4 were weaned from ECMO, 3 survived 30 days and 2 survived more than 1 year. The most frequent complication (5 patients) and the cause of death (3 patients) was bleeding. Conclusions Our experience suggests that early V‐A ECMO in patients with VSR and refractory CS might prevent irreversible multiorgan failure by improved end‐organ perfusion. Bleeding complications remain an important limitation of this approach.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A rationale for early extracorporeal membrane oxygenation in patients with postinfarction ventricular septal rupture complicated by cardiogenic shock

Rob

Špunda

Lindner

et al. 2017

European J of Heart Fail

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“…Tang et al [18] and Yalcinkaya et al [19] also revealed a similar incidence of risk factors. On the other hand, other studies showed that in addition to hypertension, the incidence of diabetes was often as high as 44.7% and in another study 65.5% [20,21]. With reference to the group we analyzed (13; 25%), their results are very high.…”

Section: Occurrence Of Patients' Risk Factors For Mechanical Complicamentioning

confidence: 70%

Atypical form of microscopic colitis in 56-year-old patient presenting with long-lasting watery diarrhea

Kiełtucki¹,

Zając²

2019

Ann. Acad. Med. Siles.

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Mikroskopowe zapalenie jelita grubego to częsta przyczyna przewlekłej biegunki niewiadomego pochodzenia. Choroba charakteryzuje się obecnością objawów klinicznych, makroskopowo prawidłowym wyglądem błony śluzowej jelita grubego w kolonoskopii i obecnością typowych zmian w badaniu histopatologicznym. Celem pracy jest przedstawienie nietypowego obrazu histologicznego mikroskopowego zapalenia jelita grubego. Autorzy prezentują przypadek 56-letniego mężczyzny z uporczywą, wodnistą biegunką, z pochopnie rozpoznaną niewydolnością zewnątrzwydzielniczą trzustki. Po wykluczeniu infekcyjnego tła biegunki wykonano kolonoskopię, ukazując makroskopowo niemal prawidłowy obraz jelita grubego. Otrzymano niespójne wyniki badań histopatologicznych. W badaniu mikroskopowym wycinków z okrężnicy potwierdzono rozpoznanie kolagenowego mikroskopowego zapalenia jelita grubego (w preparacie grubość kolagenu podnabłonkowego wynosiła > 10 µm, liczba limfocytów śródnabłonkowych < 20 w przeliczeniu na 100 komórek nabłonka). Tymczasem podczas kontrolnej kolonoskopii w wycinkach z jelita grubego ujawniono cechy zapalenia limfocytowego, w badanych próbkach nie wykazano obecności złogów podnabłonkowego kolagenu. Autorzy analizują czynniki ryzyka zachorowania, odpowiedź na zastosowane leczenie, przebieg kliniczny choroby oraz rozbieżne wyniki badań histopatologicznych.

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“…Post-MI VSD is often presented with total left anterior descending artery (LAD) occlusion; it mostly occurs at anterolateral localization and less often at posterior localization after inferior MI (2) . A 55 year old male patient came to the emergency room with chest pain.…”

mentioning

confidence: 99%

Late-Onset Post-Infarction Ventricular Septal Defect: Surgical Repair

Çevirme¹,

Kılıçgedik²,

Öğredik³

et al. 2016

Kosuyolu Heart Journal

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Post-myocardial infarction (MI) ventricular septal defect (VSD) one of the fatal complications of acute coronary syndrome-is a rare clinical situation (incidence, 1-2%) (1) . Post-MI VSD is often presented with total left anterior descending artery (LAD) occlusion; it mostly occurs at anterolateral localization and less often at posterior localization after inferior MI (2) . A 55 year old male patient came to the emergency room with chest pain. He was diagnosed with inferior MI and was taken to the angiography laboratory for primary percutaneous coronary intervention (PCI). There was ST elevation at the inferior leads on electrocardiogram. On angiography, LAD and circumfl ex artery (Cx) were normal-without critical stenotic lesions and distal RCA was totally occluded ( Figure 1A,1B,2A). The stenotic lesion was opened with successful PCI and stent implantation ( Figure 2B,C). The patient was discharged with cure. The same patient came with the complaints of fatigue and exertional dyspnea 1 month later. On echocardiography, a ventricular septal defect was seen at the anterior portion of the septum near the baseline segment of the heart. On arrival, his blood pressure was 90/60 mmHg and pulse was 100 bpm. He was immediately admitted to the ICU. After stabilization with inotropic support and intraaortic balloon pump, he was urgently taken to the operating room. The operation was performed under general anesthesia and cardiopulmonary bypass. An incision was made on the diaphragmatic surface of the heart through the left ventricle next to the interventricular septum. The interior of the left ventricle was exposed with this incision, and the septal defect on the anterior surface near the baseline of the heart was repaired with a Dacron patch. Being reinforced with Tefl on felt, the ventriculotomy incision was closed primarily ( Figure 3A,B,C). Post-MI VSD is often seen as a complication of anterior MI. It is primarily involved with total LAD occlusion and less often with additional Cx and/or right coronary artery (RCA) lesion(s). In this case, the interesting point is that LAD and Cx were completely normal without critical stenotic lesions while the isolated total RCA occlusion was seen. Post-MI VSD can be seen

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Risk factors and outcome analysis after surgical management of ventricular septal rupture complicating acute myocardial infarction: a retrospective analysis

Cited by 43 publications

References 27 publications

A rationale for early extracorporeal membrane oxygenation in patients with postinfarction ventricular septal rupture complicated by cardiogenic shock

A rationale for early extracorporeal membrane oxygenation in patients with postinfarction ventricular septal rupture complicated by cardiogenic shock

Atypical form of microscopic colitis in 56-year-old patient presenting with long-lasting watery diarrhea

Late-Onset Post-Infarction Ventricular Septal Defect: Surgical Repair

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