Transcatheter closure of a ruptured ventricular septum following inferior myocardial infarction and cardiogenic shock

Schiele, Thomas M.; Kozlik‐Feldmann, Rainer; Sohn, Hae-Young; Stempfle, Hans‐Ulrich; Küchle, Claudius; Schopohl, Jochen; Theisen, K.; Leibig, Marcus; Klauß, Volker

doi:10.1002/ccd.10616

Cited by 8 publications

(4 citation statements)

References 57 publications

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“…Newer off-pump techniques include external septal plication for VSR 82 and repair of free wall rupture with surgical glue and a Gore-Tex patch. 83 Percutaneous VSR repair has been reported for simple and complex defects 84 and after failure of surgical repair. 85 Percutaneous repair is accomplished via venous access with septal occluders that consist of 2 disks connected by a waist.…”

Section: Treatment Of Cs Due To Mechanical Complicationsmentioning

confidence: 99%

Cardiogenic Shock

2008

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ardiogenic shock (CS) occurs in Ϸ5% to 8% of patients hospitalized with ST-elevation myocardial infarction (STEMI). Recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems play a role in the pathogenesis and persistence of CS. Early revascularization for CS improves survival substantially. New mechanical approaches to treatment are available, and clinical trials are feasible even in this high-risk population. Most importantly, hospital survivors have an excellent chance for long-term survival with good quality of life. This review will outline the causes, pathophysiology, and treatment of CS with a focus on CS complicating myocardial infarction (MI.) The case will be made for viewing CS as a serious disorder with a high early death rate, but one that is treatable and that, if approached aggressively, can result in full recovery. The diagnosis is usually made with the help of pulmonary artery (PA) catheterization; however, Doppler echocardiography may also be used to confirm elevation of LV filling pressures. 1 Hypoperfusion may be manifest clinically by cool extremities, decreased urine output, and/or alteration in mental status. Hemodynamic abnormalities form a spectrum that ranges from mild hypoperfusion to profound shock, and the short-term outcome is directly related to the severity of hemodynamic derangement. MI with LV failure remains the most common cause of CS. It is critical to exclude complicating factors that may cause shock in MI patients. Chief among these are the mechanical complications: ventricular septal rupture, contained free wall rupture, and papillary muscle rupture. Mechanical complications must be strongly suspected in patients with CS complicating nonanterior MI, particularly a first MI. Echocardiography is the technique of choice to rule out these entities and should be performed early unless the diagnosis is extensive anterior MI and the patient is undergoing prompt percutaneous coronary intervention (PCI). In addition, the detection of valvular disease before angiography may alter the revascularization approach. Diagnosis and CausesHemorrhage, infection, and/or bowel ischemia may contribute to shock in the setting of MI. As with mechanical complications, a high index of suspicion is required to make these diagnoses in MI patients, and survival may depend on timely recognition and treatment.Any cause of acute, severe LV or RV dysfunction may lead to CS. Acute myopericarditis, tako-tsubo cardiomyopathy, and hypertrophic cardiomyopathy may all present with ST elevation, release of cardiac markers, and shock in the absence of significant coronary artery disease. Stress-induced cardiomyopathy, also known as apical ballooning or takotsubo cardiomyopathy, is a syndrome of acute LV dysfunction after emotional or respiratory distress that leads to CS in 4.2% of cases. 2 Acute valvular regurgitation, typically caused by endocarditis or chordal rupture due to trauma or degenerative disease, may also cause CS. Aortic dissection may lead to CS via acute,...

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Section: Treatment Of Cs Due To Mechanical Complicationsmentioning

confidence: 99%

Cardiogenic Shock

2008

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“…Percutaneous VSD closure following MI or recurrence after surgical repair has been described as an alternative treatment and has been shown to be safe and effective with favorable outcome when done at the right time and in the right patient [3, 8–10]. Device embolization, hemolysis, ventricular perforation, or death have been reported as rare major complications of percutaneous VSD closure [5–7]. Cardiac perforation is a very rare complication of diagnostic and interventional procedures which may need an urgent treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous VSD closure has been proposed as an alternative with favorable outcome in selected patients, specially when the procedure can be postponed for more than 2 weeks after the onset of acute MI [3, 4]. Major procedure‐ or device‐related complications following percutaneous VSD closure include device embolization, hemolysis, cardiac perforation, or death [5–7].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous closure of a postinfarction ventricular septal defect and an iatrogenic left ventricular free‐wall perforation using two Amplatzer muscular VSD occluders

Eshtehardi

Garachemani

Meier

2009

Cathet Cardio Intervent

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A 83-year-old woman underwent percutaneous closure of postinfarction ventricular septal defect following anteroseptal myocardial infarction and percutaneous coronary intervention with stent implantation of the left anterior descending coronary artery. Postinfarction percutaneous ventricular septal defect closure was initially complicated by an iatrogenic left ventricular free-wall perforation. Both defects were closed using two Amplatzer muscular VSD occluders during the same session.

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“…Other methods have been used to delay surgery and improve hemodynamic status, including temporary closure of a VSD with a Swan-Ganz balloon catheter (Abhyankar and Jagtap, 1999), calibrated sizing balloon (Zanchetta et al, 2003) or Amplatzer occluder (Schiele et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Postinfarction Ventricular Septal Rupture – A Rare Complication Remains Challenge for Cardiac Surgical Team

et al. 2013

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R e c e i ve d Ju ly 2 6 , 2 0 1 2 ; A c c e p t e d J a nu a r y 1 5 , 2 0 1 3 . Key words: Myocardial infarction -Ventricular septal rupture -Ventricular assist deviceAbstract: The incidence of post infarction ventricular septal rupture (PIVSR) is decreasing in the last years due to aggressive treatment of myocardial infarction with early percutaneous coronary interventions. As a consequence patients with PIVSR are referred to surgery more often with significant heart failure. The aim of this retrospective study was to assess the influence of these on the operative results and to identify the risk factors of operative mortality. A retrospective analysis of prospectively collected data of patients with the PIVSR admitted to our center from November 2004 to February 2012 was performed. Variables were analyzed using two-dimensional correspondence analysis. There were 25 patients (12 males and 13 females) with mean age 70.2 years (47-82) operated on; 17 (68%) presented with anterior and 8 (32%) with posterior PIVSR. Eighteen patients (72%) had acute heart failure, 13 (52%) presented with cardiogenic shock. Before surgery, intraaortic balloon pump (IABP) had 20 (80%) patients; in 4 (16%) a ventricular assist device was used, either Extracorporeal Membrane Oxygenation (ECMO) or centrifugal pumps as biventricular assist. Operative mortality was 40% (10 pts.). Four patients (12%) had small non-significant recurrent shunt on postoperative echocardiography. Although majority of patients with PIVSR have significant heart failure prior to surgery the operative mortality remains comparable to older studies. Predictors of perioperative death were concomitant surgical reconstruction of the left ventricle, renal impairment before operation, male gender, history of coronary artery disease, PIVSR location posterior, and shock at surgery.

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Transcatheter closure of a ruptured ventricular septum following inferior myocardial infarction and cardiogenic shock

Cited by 8 publications

References 57 publications

Cardiogenic Shock

Cardiogenic Shock

Percutaneous closure of a postinfarction ventricular septal defect and an iatrogenic left ventricular free‐wall perforation using two Amplatzer muscular VSD occluders

Postinfarction Ventricular Septal Rupture – A Rare Complication Remains Challenge for Cardiac Surgical Team

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