Techniques, Timing &amp; Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas

Malhotra, Amber; Patel, Kartik; Sharma, Pranav; Wadhawa, Vivek; Madan, Tarun; Khandeparkar, Jagdish; Shah, Komal; Patel, Sanjay

doi:10.21470/1678-9741-2016-0032

Cited by 28 publications

(57 citation statements)

References 20 publications

(42 reference statements)

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“…A long time between MI and surgery recommends the heart is well collateralized and systems have had enough time to adjust to changed hemodynamics. They mentioned that the institution of Intra-aortic balloon pump (IABP) before surgery can stabilize the patients by reducing the afterload of the left ventricle and recovers coronary circulation [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

“…Studies showed that earlier repair and operation in VSR patients increases the risk of mortality. It could be clarified by the fact that unstable hemodynamics and ischemia-reperfusion damage to an infarcted myocardium increases the injury of the myocardium [ 28 ]. Time is needed to restore heart muscle tissues in the necrotic part.…”

Section: Discussionmentioning

confidence: 99%

“…In the early phase after MI, infarcted myocardium is fragile, and it is hard for the surgeon to work around the septal rupture properly and increases the risk of laceration and recurrent septal defects [ 38 ]. A short interval between MI and VSR is indicative of severe ischemia and inaccessibility of collateral circulation [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

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Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction

Shafiei¹,

Jannati²,

Jannati³

2020

Journal of the Saudi Heart Association

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Ventricular septal rupture (VSR) is an uncommon complication of myocardial infarction (MI). The mortality rate of VSR is high. The management of VSR is including the stabilization of the hemodynamic status and surgical closure of the rupture. In spite of the agreement of experts on the necessity of surgical repair, the timing of VSR repair management remains unclear. In this review article, we evaluate the optimal time repair of VSR. To collect the data, Pubmed, EMBASE, and Cochrane Central Registry databases were searched for potentially suitable studies. Search terms were including “Ventricular Septal Rupture”, “Myocardial Infarction”, “Timing”, and “MI”. According to the result of the studies, it seems that the time between VSR detection and its repair is a determining factor in the survival or mortality of patients in post-myocardial infraction VSR. Studies showed that earlier surgical repair in VSR increases the risk of mortality, because in the early phase after MI, infarcted myocardium is very fragile, and it is very difficult surgical repair and increases the risk of recurrent septal defects. The longer time is needed for the heart and different body systems to adapt to the hemodynamic results of the abrupt left to right shunt. It seems that the best time for the operation is after the maturation of VSR with scarring at the edges of the defect. Moreover, in a large number of patients, it is not possible to delay the operation since they are at risk of severe heart failure and organ dysfunction. In these cases operation immediately after diagnosis of VSR is recommended to prevent further hemodynamic deterioration. In hemodynamically compromised patients, it may be considered to use a ventricular assist device, requiring an intra-aortic balloon pump (IABP), or extracorporeal membrane oxygenation (ECMO) preoperative to postpone the operation which leads to higher survival in post-MI-VSD.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction

Shafiei¹,

Jannati²,

Jannati³

2020

Journal of the Saudi Heart Association

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“…Nevertheless, an important heterogeneity concerning the timing of transcatheter closure can be observed among studies [5-10]. The current ST-elevation myocardial infarction (STEMI) guidelines of the European Society of Cardiology (ESC) and the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) recommend urgent PI-VSR closure irrespective of hemodynamic status [11, 12], but the timing of PI-VSR closure and perioperative therapeutic management remain controversial [13]. In previous studies, most percutaneous device closures were performed during the subacute and chronic periods (≥2 weeks) after the initial detection of PI-VSR [4, 8, 10, 14].…”

Section: Introductionmentioning

confidence: 99%

Management and Outcome of Ventricular Septal Rupture Complicating Acute Myocardial Infarction: What Is New in the Era of Percutaneous Intervention?

Tai¹,

Tang²,

Tang³

et al. 2018

Cardiology

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Background: Postinfarction ventricular septal rupture (PI-VSR) is a rare but devastating complication of acute myocardial infarction (AMI). Risk stratification in the acute phase is crucial for decision-making, and this study analyzed the risk factors for early mortality and the effects of various management options on the outcome of PI-VSR patients in the era of percutaneous intervention. Methods: A total of 96 patients with PI-VSR were identified and divided into an acute-phase survivor group (n = 46, survived ≥2 weeks after admission) and a nonsurvivor group (n = 50, died within 2 weeks after admission). Percutaneous closure was considered in acute-phase survivors. Patients were followed up for a mean 47 (quartiles 15–71) months by clinical visit or telephone interview. Results: The overall acute-phase (i.e., < 2 weeks after the diagnosis of PI-VSR) mortality rate was 52%. Female sex and Killip Class III–IV at admission were associated with an increased risk of acute-phase death. Of the 46 patients who survived ≥2 weeks, 20 underwent interventional occlusion and the procedure was successful in 19. Percutaneous closure in the acute-phase survivor group improved the immediate (21% in-hospital mortality rate) and long-term (53% mortality) outcomes. Conclusions: Patients with PI-VSR are at a high risk of acute-phase mortality. Female sex and severe cardiac dysfunction at admission are linked with a high rate of acute-phase deaths. Percutaneous closure in acute-phase survivors results in favorable short- and long-term benefits for PI-VSR patients.

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“…In a retrospective single‐center study by Malhotra et al, reporting on 55 cases with post‐MI‐VSR aiming to identify factors affecting the prognosis of this complication, shorter intervals between VSR and surgery were found to be a strong and probably the most important predictor of mortality. It was suggested that if the surgery could be delayed for more than 3 days after the occurrence of VSR, a 50% reduction in mortality could be expected . However, it is debatable whether this conclusion could be generalized to patients with a combination of VSR and IMD.…”

Section: Discussionmentioning

confidence: 99%

Postinfarction intramyocardial dissection, an interesting case report and systematic review

et al. 2019

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Intramyocardial dissection (IMD) with ventricular septal rupture (VSR) following myocardial infarction (MI) is a rare subacute form of cardiac rupture. The evidence available in this regard is scarce. We aimed to share our experience and conduct a systematic review of previous cases. We searched the literature and performed a systematic review of previous cases. A total of 37 cases of IMD with VSR were included (1 our original and 36 literature cases). Mean age was 68 ± 8 years and 20 (54.1%) patients were male. Anterior and inferior MI were observed in 14 (37.8%) and 23 (62.2%) cases, respectively. The dissected area was the septum, RV, both septum and RV, or LV apex in 21 (56.8%), 9 (24.3%), 5 (13.5%), and 2 (5.4%), respectively. Apicoseptal and inferoseptal VSR were observed in 15 (40.5%) and 22 (59.5%) cases, respectively. At least one occluded artery was observed in 29 (90.6%) of cases. Reperfusion therapy was done for 15 (40.5%) cases before the VSR occurred.Surgery, percutaneous, and medical therapy were done for 26 (70.3%), 3 (8.1%), and 7 (18.9%) cases, respectively. The mortality rate was significantly higher in the medical versus surgical-treated group (85.7% versus 42.3%, P = .027). There was a trend to higher mortality in the group with dissection of both septum and RV (P = .15). We concluded that echocardiography has a critical role in diagnosing this complication.Surgery is mandatory in IMD with VSR.

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Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas

Cited by 28 publications

References 20 publications

Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction

Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction

Management and Outcome of Ventricular Septal Rupture Complicating Acute Myocardial Infarction: What Is New in the Era of Percutaneous Intervention?

Postinfarction intramyocardial dissection, an interesting case report and systematic review

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