Surgical repair of post-infarction ventricular septal defect: 19 years of experience

Mantovani, Vittorio; Mariscalco, Giovanni; Leva, Cristian; Blanzola, Claudio; Sala, A.

doi:10.1016/j.ijcard.2005.05.007

Cited by 48 publications

(58 citation statements)

References 21 publications

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“…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][6][7][8][9][10][11] Because 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.…”

mentioning

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 recently published study of one centre's 19 years of experience of surgical repair of post-infarction VSD (50 patients), the operative mortality was 36% and emergency operation or early operation after rupture (<3 days) was a predictor of early mortality. 19 Patients with post-infarction VSD should be considered for emergent or early surgical revascularisation. 20 Transcatheter closure offers an alternative to the highrisk surgery, especially for those who are of advanced age or have other co-morbidities, but is still a technique in evolution.…”

Section: Transcatheter Closure Of Post-myocardial Infarction Ventricumentioning

confidence: 99%

The New World of Cardiac Interventions: A Brief Review of the Recent Advances in Non-Coronary Percutaneous Interventions

Garg

Walton

2008

Heart, Lung and Circulation

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“…A shorter time interval between perforation and surgery is an increased risk for mortality and procedural complication because friable necrotic tissue surrounding infarcted tissue provides poor support for sutures. 10 The reduced operative mortality in patients whose surgery is delayed could, however, be attributed to the fact that these patient's self-select themselves, as they tend to have a less severe hemodynamic insult, which is better tolerated.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic identification of ventricular septal rupture caused by acute stent thrombosis

Garg

Bourantas

Thackray

et al. 2009

J of Clinical Ultrasound

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Coronary stenting is an increasingly common procedure. Complications are rare. However, when they do occur, they often require urgent invasive treatment. Investigations that are critical for establishing a diagnosis as well as such guide treatment as a detailed assessment of myocardial morphology and function using transthoracic echocardiography may be overlooked in the haste to treat the patient. We present a case report of subacute drug-eluting stent thrombosis in which a meticulous echocardiographic examination allowed the identification of a ventricular septal rupture, which ultimately modified treatment.

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Surgical repair of post-infarction ventricular septal defect: 19 years of experience

Cited by 48 publications

References 21 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

The New World of Cardiac Interventions: A Brief Review of the Recent Advances in Non-Coronary Percutaneous Interventions

Echocardiographic identification of ventricular septal rupture caused by acute stent thrombosis

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