Urgent hybrid approach in treatment of the acute myocardial infarction complicated by the ventricular septal rupture

Radosavljevic-Radovanovic, Mina; Radovanović, Nebojša; Arandjelović, Aleksandra; Mitrović, M; Ušćumlić, Ana; Stanković, Goran

doi:10.2298/sarh1404226r

Cited by 4 publications

(5 citation statements)

References 8 publications

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“…For high-risk, hemodynamically unstable VSR and cardiogenic shock, the recommended treatment is initial percutaneous coronary intervention (PCI) of the infarct-related artery, followed by immediate surgical closure of the ventricular septal rupture. This approach is expected to quickly establish blood flow and reduce the risks, time, and complexity of the urgent cardiosurgical intervention [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Ventricular Septal Rupture and Artificial Intelligence (AI)-Assisted Healthcare

Vallath¹,

Sivasubramanian²,

Chatterjee³

et al. 2023

Cureus

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This case report highlights the use of point-of-care ultrasound (POCUS) for the diagnosis of ventricular septal rupture (VSR), a severe consequence of acute myocardial infarction (AMI). VSR has a broad spectrum of signs and inconspicuous symptoms, making the diagnosis difficult. POCUS offers non-invasive, real-time cardiac imaging and has an advantage over other methods due to its ability to identify VSR early. Here we present a 63-year-old female with a history of type 2 diabetes, hypothyroidism, hyperlipidemia, and a family history of cardiovascular disease, who came to the ED with chest pain for three days, palpitations, and dyspnea at rest. On examination, the patient was hypotensive, tachycardic, and had crackles with a harsh holosystolic murmur. An EKG and elevated troponin levels suggested acute on chronic anterior-lateral wall ST-elevation myocardial infarction (STEMI). Resuscitation efforts were initiated, followed by a lung ultrasound that revealed good lung sliding and multiple B lines without pleural thickening, indicating pulmonary edema. Echocardiography revealed ischemic heart disease with moderate left ventricle (LV) systolic dysfunction and a 14 mm apical ventricular septal rupture (hypokinetic thinning of the anterior wall, septum, apex, and anterolateral wall with a left ventricular ejection fraction (LVEF) of 39%). The presence of flow on color Doppler across the interventricular septum, showing left-to-right shunting, led to a definitive diagnosis of acute-on-chronic myocardial infarction (MI) with ventricular septal rupture. The case report also emphasizes how modern AI applications like ChatGPT (OpenAI, San Francisco, California, United States), aid in language and research, saving time and redefining the healthcare and research industry. As a result, we are confident that AI-assisted healthcare will be the next global breakthrough.

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Section: Discussionmentioning

confidence: 99%

Ventricular Septal Rupture and Artificial Intelligence (AI)-Assisted Healthcare

Vallath¹,

Sivasubramanian²,

Chatterjee³

et al. 2023

Cureus

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“…The most likely explanation for the mentioned difference was the other treatment strategy for each patient, dictated by the clinical symptoms. Radosavljević-Radovanović et al [29] found that despite improved treatment, surgical technique and percutaneous revascularization, the mortality rate ranged from 24% to 87%. The patients treated pharmacologically showed an even greater mortality rate -90%.…”

Section: Treatment Methods and Survival Of Patients With Mechanical Comentioning

confidence: 99%

Atypical form of microscopic colitis in 56-year-old patient presenting with long-lasting watery diarrhea

Kiełtucki¹,

Zając²

2019

Ann. Acad. Med. Siles.

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Mikroskopowe zapalenie jelita grubego to częsta przyczyna przewlekłej biegunki niewiadomego pochodzenia. Choroba charakteryzuje się obecnością objawów klinicznych, makroskopowo prawidłowym wyglądem błony śluzowej jelita grubego w kolonoskopii i obecnością typowych zmian w badaniu histopatologicznym. Celem pracy jest przedstawienie nietypowego obrazu histologicznego mikroskopowego zapalenia jelita grubego. Autorzy prezentują przypadek 56-letniego mężczyzny z uporczywą, wodnistą biegunką, z pochopnie rozpoznaną niewydolnością zewnątrzwydzielniczą trzustki. Po wykluczeniu infekcyjnego tła biegunki wykonano kolonoskopię, ukazując makroskopowo niemal prawidłowy obraz jelita grubego. Otrzymano niespójne wyniki badań histopatologicznych. W badaniu mikroskopowym wycinków z okrężnicy potwierdzono rozpoznanie kolagenowego mikroskopowego zapalenia jelita grubego (w preparacie grubość kolagenu podnabłonkowego wynosiła > 10 µm, liczba limfocytów śródnabłonkowych < 20 w przeliczeniu na 100 komórek nabłonka). Tymczasem podczas kontrolnej kolonoskopii w wycinkach z jelita grubego ujawniono cechy zapalenia limfocytowego, w badanych próbkach nie wykazano obecności złogów podnabłonkowego kolagenu. Autorzy analizują czynniki ryzyka zachorowania, odpowiedź na zastosowane leczenie, przebieg kliniczny choroby oraz rozbieżne wyniki badań histopatologicznych.

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“…(1,2) Its mortality rate is 24-87% and 90% in patients with and without definitive surgery, respectively. (3,4,5) Defect size, hemodynamic status, and comorbidities may predispose the mortality on VSR cases. (3,4) Surgical closure should be performed immediately in large VSRs (≥ 15 mm) to prevent embolizations.…”

Section: Introductionmentioning

confidence: 99%

“…(3,4,5) Defect size, hemodynamic status, and comorbidities may predispose the mortality on VSR cases. (3,4) Surgical closure should be performed immediately in large VSRs (≥ 15 mm) to prevent embolizations. Meanwhile, amplatzer closure is recommended for small-medium VSRs ≤15 mm to stabilize the patients' hemodynamic and may also be used as a temporary correction.…”

Section: Introductionmentioning

confidence: 99%

“…Inadequate stenting will require coronary artery bypass grafting (CABG) to prevent the risk of surgical complications and continued with the defect closure. (3,7,8,9) Therefore, management of VSR involves a multidisciplinary approach. Meanwhile, patient delay (refusal of treatment) and lack of medical facilities put other challenges in VSR management.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Percutaneous Coronary Intervention in Post-Infarction Ventricular Septal Rupture

Suryono¹,

Naesilla

Kurniasari

et al. 2021

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Background: Ventricular septal rupture (VSR) is a fatal mechanical complication following acute myocardial infarction (AMI). The definitive treatment remains surgical repair, however several aspects are still debatable, including the timing of surgery. Patient’s refusal of treatment and lack of medical facilities put other challenges in management of VSR. Case presentation: A-48-year-old male with a history of diabetes mellitus and hypertension came with a late-presentation anterior AMI, and refused the reperfusion therapy. By the third day, he developed VSR and cardiogenic shock. The patient was also against any referral plan for further therapy. Hemodynamic status was optimally controlled with vasopressor and inotropic agents. The patient was discharged with a grade II-III New York Heart Association (NYHA) on the tenth day. In follow up evaluation a week later, the patient presented limb swelling and functional NYHA class III-IV. The patient agreed to received percutaneous coronary intervention (PCI). Drug eluting stent (DES) in left anterior descending (LAD) coronary artery was implanted successfully without defect closure. Follow-up after 12-months revealed no signs or symptoms of decompensated heart failure. Keywords: ventricular septal rupture; percutaneous coronary intervention; acute myocardial infarction

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Urgent hybrid approach in treatment of the acute myocardial infarction complicated by the ventricular septal rupture

Cited by 4 publications

References 8 publications

Ventricular Septal Rupture and Artificial Intelligence (AI)-Assisted Healthcare

Ventricular Septal Rupture and Artificial Intelligence (AI)-Assisted Healthcare

Atypical form of microscopic colitis in 56-year-old patient presenting with long-lasting watery diarrhea

Percutaneous Coronary Intervention in Post-Infarction Ventricular Septal Rupture

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