Thirteen-year survival with acquired interventricular septal defect after myocardial infarction

Landale, Donald G.; Schlappi, John C.

doi:10.1016/0002-8703(62)90087-x

Cited by 25 publications

(2 citation statements)

References 52 publications

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“…3 Although there have been a few reports of long-term survival. 4 this lesion usually is fatal, with up to 24% of the patients dying within 24 hours and 80-90% within 2 months. 5 -K Earlier reports of surgical therapy have recommended waiting up to 2 months, if possible, before undertaking closure of the VSD.…”

Section: Balloon-induced Right Ventricular Outflow Obstructionmentioning

confidence: 99%

Balloon-induced right ventricular outflow obstruction: a new approach to control of acute interventricular shunting after myocardial infarction in canines and swine.

Babb¹,

Waldhausen²,

Zelis³

1977

Circulation Research

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Current management of ventricular septal defect (VSD) after myocardial infarction (MI) is aimed at improving left ventricular (LV) performance by afterload reduction as a means of hemodynamic stabilization or shunt control. The current investigation was undertaken to determine whether primary manipulation of right venticular (RV) performance by afterload enhancement was an effective means of reducing MI-VSD shunting. In five open-chest dogs an external LV-RV shunt was created with pulmonary-systemic flow ratios (Qp/Qs) averaging 2.26:1. Inflation of a balloon-tipped catheter in the main pulmonary artery (PA) reduced average QP/Qs to 1.28:1 and shunt flow from 783 to 343 ml/min. However, this increase in RV afterload caused further significant increases in RV systolic and end-diastolic pressure and suggested that deterioration of RV function might be limiting the usefulness of this technique. To investigate whether inotropic support for the RV would overcome this limitation, a similar shunt was created in 11 open-chest swine. We then investigated the effects of dopamine, infused at 24, 60, and 120 mug/min, on QP/QS and other hemodynamic variables both with and without PA balloon inflation. Optimal shunt control was obtained when effects of dopamine were added to those of PA balloon inflation. Shunt flow that had been 1,633 ml/min was reduced to 892 ml/min with the PA balloon and reduced further to 757 ml/min with dopamine, which also lowered RV and LV end-diastolic pressure and reduced total systemic vascular resistance. In four other swine with left anterior descending ligations, PA balloon inflation and dopamine infusion again favorably affected hemodynamics. Epicardial mapping in these swine showed an increase in S-T segment displacement, suggesting that the cumulative effect of these interventions allowed hemodynamic improvement at the expense of enhanced ischemic injury. These data indicate that acute RV outflow obstruction with a balloon catheter is an effective means of temporarily reducing acute ventricular shunting and that dopamine may be a useful pharmacological agent to use with RV afterload manipulation to stabilize a patient prior to transfer to a medical center for more definitive therapy.

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Section: Balloon-induced Right Ventricular Outflow Obstructionmentioning

confidence: 99%

Balloon-induced right ventricular outflow obstruction: a new approach to control of acute interventricular shunting after myocardial infarction in canines and swine.

Babb¹,

Waldhausen²,

Zelis³

1977

Circulation Research

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“…Because of its grave prognosis and the progress of surgical techniques, the recent therapeutic strategy for VSP is to surgically repair it as soon as possible. Therefore, there are few reports on cases ofVSPwhohave survived for long time without surgical treatment, with only 14 cases documented in Japan and overseas (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) (Table 1). Weencountereda rare case with VSPwhowasundiagnosed for 9 years after myocardial infarction and still remains asymptomatic 14 years later.…”

Section: Introductionmentioning

confidence: 99%

Fourteen-Year Survival in a Case of Ventricular Septal Perforation after Myocardial Infarction.

et al. 2000

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Wetreated a case of ventricular septal perforation (VSP) who survived for 14 years after myocardial infarction. Nine years after the onset of myocardial infarction, an apparent cardiac murmurwas discovered by chance, and following further examination, the patient was diagnosed as having VSP. The patient is still in the NYHA functional class I, and requiring no surgical treatment. In general, the prognosis of myocardial infarction complicated with VSPis so poor that there have only been 14 reported cases of long survival without surgical treatment. Amongthese patients, only 2 survived for more than 10 years. The present case is extremely rare, and evidently is the longest living survivor with this condition yet reported.

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Closure of Ventricular Septal Defect Following Myocardial Infarction

Padhi¹

1967

Arch Surg

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Thirteen-year survival with acquired interventricular septal defect after myocardial infarction

Cited by 25 publications

References 52 publications

Balloon-induced right ventricular outflow obstruction: a new approach to control of acute interventricular shunting after myocardial infarction in canines and swine.

Balloon-induced right ventricular outflow obstruction: a new approach to control of acute interventricular shunting after myocardial infarction in canines and swine.

Fourteen-Year Survival in a Case of Ventricular Septal Perforation after Myocardial Infarction.

Closure of Ventricular Septal Defect Following Myocardial Infarction

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