Surgically remediable complications of myocardial infarction

Fox, Arthur C.; Glassman, Ephraim; Isom, O. Wayne

doi:10.1016/0033-0620(79)90026-4

Cited by 73 publications

(11 citation statements)

References 115 publications

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“…Almost 50% of untreated patients die within the first week [10]. Sudden hemodynamic deterioration as well as an increase in the VSD size is common, even in patients who appear clinically stable and well [11].…”

Section: Introductionmentioning

confidence: 99%

Transcatheter closure of postinfarction ventricular septal defects using the new Amplatzer muscular VSD occluder: Results of a U.S. Registry

Holzer

Balzer

Amin

et al. 2004

Cathet Cardio Intervent

207

142

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The objective of this study was to assess the immediate and mid-term results of transcatheter closure of postinfarct muscular ventricular septal defects (VSDs) using the new Amplatzer postinfarct muscular VSD device (PIMVSD). Ventricular septal rupture occurs in 0.2% of myocardial infarcts and remains associated with very high morbidity and mortality. Data were prospectively collected for 18 patients who underwent attempted device closure of postinfarction VSDs between 2000 and 2003. Five patients underwent the closure in the acute phase (within 6 days from the infarct); the remaining patients underwent closure on day 14-95 after the diagnosis of the infarct. Outcome parameters included procedural success, evidence of residual shunts on echocardiography, and occurrence of procedure-related complications. The procedure was successful in deploying a device across the VSD in 16 of 18 patients. The 30-day mortality was 28%. Eleven patients are still alive and have been followed up for a median of 332 days. Two patients required a second procedure to close a residual VSD. At the most recent outpatient follow-up, the VSD was completely closed in two patients, six patients had a trivial or small residual shunt, and two patients had a moderate residual shunt. We conclude that percutaneous device closure of postinfarction VSDs using the Amplatzer PIMVSD occluder appears to be safe and effective. Further trials are required to assess long-term efficacy and compare the results with those of surgical closure.

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Section: Introductionmentioning

confidence: 99%

Transcatheter closure of postinfarction ventricular septal defects using the new Amplatzer muscular VSD occluder: Results of a U.S. Registry

Holzer

Balzer

Amin

et al. 2004

Cathet Cardio Intervent

207

142

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“…33. Calcula-se mortalidade de 24% nas primeiras 24 horas de sua instalação, 46% na primeira semana, 65% em 2 semanas, 67% a 87% em 2 meses e sobrevida de apenas 5 a 7% ao final de 1 ano 7 gumas vezes superior à sistêmica, aumentando o fluxo E-D 38. Além disso, sua administração geralmente acarreta ao paciente hipotensão severa, comprometendo ainda mais seu estado geral.…”

Section: Introductionunclassified

Tratamento cirúrgico da comunicação interventricular pós infarto agudo do miocárdio: conduta atual

Dallan

Oliveira

Ramires

et al. 1989

Rev Bras Cir Cardiovasc

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RESUMO: Os autores descrevem sua experiência com o tratamento cirúrgico de 42 pacientes portadores de c;omunicação interventricular (CIV) pós infarto agudo do miocárdio (IAM). Destacam a elevada mortalidade cirúrgica nos pacientes com choque cardiogênico instalado (66,6%) em relação aos demais (9,5%) . A observação de descompensações súbitas em pacientes hemodinâmicamente estáveis tem levado à indicação cirúrgica precoce, se possível, assim que estabelecido o diagnóstico da rotura do septo interventricular (RSI). O comprometimento de múltiplas artérias coronárias e faixas etárias elevadas foram considerados fatores agravantes no prognóstico cirúrgico. O mesmo não ocorreu com a relação fluxo pulmonar/sistémico e shunt E-O , que não guardaram relação com a mortalidade . A técnica de exposição de ambas as cavidades ventriculares e reforço das 2 faces do septo roto com tecido biológico tem fornecido resultados gratificantes na correção da RSI , especialmente de localização posterior. DESCRITORES: rotura ventricular, cirurgia ; comunicação interventricular, cirurgia; infarto do miocárdio, cirurgia. INTRODUÇÃOEssas evidências elegeram a correção cirúrgica como tratamento obrigatório. Persistem , entretanto, controvérsias quanto ao momento ideal para tal intervenção. Chegou-se a recomendar a espera mínima de 3 semanas após o IAM, períodO suficiente para o desenvolvimento de fibrose no tecido miocárdico, visando facilitar a correção cirúrgica e prevenir eventuais recidivas 8. 20. A contrapulsação com balão intra-aórtico, o uso de drogas vasodilatadoras e de drogas inotrópicas contribuem para a estabilização hemodinâmica -ainda que transitória -de alguns desses pacientes, postergando a intervenção cirúrgica. Entretanto, logo se observou que a ação das drogas vasodilatadoras visando reduzir a pós-carga ventricular também proporciona vasodilatação pulmonar, al-A rotura do septo interventricular (RSI) é uma complicação grave do infarto agudo do miocárdio (IAM) Sua incidência, observada por diversos autores, varia de 0,5% a 3%15. 25. 33, sendo responsável pelo óbito de 1 % a 5% do total dos pacientes infartados 7 • A eVOlução natural da doença demonstra a ineficácia do tratamento clínico isolado 32. 33. Calcula-se mortalidade de 24% nas primeiras 24 horas de sua instalação, 46% na primeira semana, 65% em 2 semanas, 67% a 87% em 2 meses e sobrevida de apenas 5 a 7% ao final de 1 ano 7.

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“…In left ventricular complete free wall ruptures account for almost 4% of patient deaths after acute myocardial infarction (33% occur within the first 24 hours, 85% within the first week), 1 complete septal ruptures (accounting for 1%-5% of all infarct-related deaths), 2 and the formation of false aneurysms. Although true aneurysms typically do not require emergency treatment, false aneurysms, or pseudoaneurysms, are the result of a complete rupture of the ventricular wall with containment of the resulting hematoma by adherent pericardium and thus have a high mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Subepicardial Aneurysm That Was Diagnosed by Cardiac Imaging and Underwent Successful Surgery

et al. 2015

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A 63-year-old man was admitted because of current chest pain with perspiration for 6 hours. Electrocardiography showed complete right bundle-branch block and ST-segment elevation on leads II, III, aVF, and V 2 through V 6 ( Figure 1); we therefore suspected an anterior and inferior wall acute myocardial infarction. Coronary angiography revealed total occlusion of the proximal left anterior descending artery (Figure 2 and Movie I in the online-only Data Supplement); the left circumflex and right coronary arteries showed no abnormalities. The left anterior descending artery was recanalized by percutaneous catheter intervention. The patient complained of chest pain the next afternoon after percutaneous catheter intervention, and the ECG was not changed. A transthoracic echocardiogram was performed, which demonstrated that the apical segments of the left ventricular walls were akinetic with normal thickness in the 4-chamber view (Movie II in the online-only Data Supplement), but the apex myocardium was dyskinetic with a perforation (2 mm in diameter) connected to a small apical aneurysm (10×5 mm) covered by intact epicardium that communicated with the left ventricular cavity as demonstrated by color Doppler ( Figure 3A and 3B and Movie III in the online-only Data Supplement) from the apical 2-chamber view. This was consistent with a subepicardial aneurysm (SEA). On the follow-up echocardiography performed 8 days after infarction, there was a small thrombus at the apex, and the false aneurysm could not be seen ( Figure 3C and Movie IV in the online-only Data Supplement).To confirm the diagnosis, cardiac magnetic resonance imaging (MRI) was performed. Axial ( Figure 4A) and shortaxis ( Figure 4B) first-pass perfusion steady-state free-precession MRIs demonstrated an area of microvascular obstruction in the apical wall (solid arrows) with an small aneurysm (open arrow) compatible with a left ventricular rupture. The magnified view ( Figure 4C) of the steady-state free-precession MRI confirmed an apical thrombus (arrow) at the area of the ruptured orifice (open arrow) covered by intact epicardium. The 2-chamber-view ( Figure 4D) delayed-enhancement inversionrecovery MRI (steady-state free-precession-gradient recalled echocardiography) after intravenous gadolinium injection showed apical acute myocardial infarction with a persistent area of microvascular obstruction (arrowheads), small apical thrombus, and a small aneurysm with clot covered by epicardium (arrow).To prevent epicardial rupture or sudden death, an aneurysmectomy was performed 28 days after infarction. During surgery, a small ruptured orifice filled with thrombus in the left ventricular apex was evident. A ventricular aneurysm resection and coronary artery bypass saphenous vein to left anterior descending artery side anastomosis operation were performed.Pathological examination showed that the endocardial layer and muscle layer structure ruptured, but the epicardial layer was intact with fibrous tissue and a small number of myocardial cells ( Figure 5). The ...

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Surgically remediable complications of myocardial infarction

Cited by 73 publications

References 115 publications

Transcatheter closure of postinfarction ventricular septal defects using the new Amplatzer muscular VSD occluder: Results of a U.S. Registry

Transcatheter closure of postinfarction ventricular septal defects using the new Amplatzer muscular VSD occluder: Results of a U.S. Registry

Tratamento cirúrgico da comunicação interventricular pós infarto agudo do miocárdio: conduta atual

Subepicardial Aneurysm That Was Diagnosed by Cardiac Imaging and Underwent Successful Surgery

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