Background Post-myocardial infarction ventricular septal defect (VSD) complicates ∼2% of myocardial infarctions. Thrombolytic therapy may accelerate the time from myocardial infarction to VSD formation. The effects of thrombolytic therapy in patients with a post-myocardial infarction VSD were investigated. Method Demographic, procedural, and event data were retrospectively analysed in patients transferred to a regional cardiothoracic centre with the diagnosis of post-myocardial infarction VSD over five years. Results Twenty nine patients were analysed; 15 received thrombolytic therapy: 10 (<12 hours) early and five (≥12 hours) late. The median time to post-myocardial infarction VSD was shorter with thrombolytic therapy at 1 v 5.5 days (p=0.01). The median time to post-myocardial infarction VSD was shorter with early compared with late thrombolytic therapy at 1 v 6 days (p<0.01). There was no difference between late and no thrombolytic therapy, 5.5 v 6 days. Patients treated with thrombolytic therapy had a trend towards higher mortality at 11/15 (73%) compared with 5/14 (36%) (p=0.066). Twenty five (86%) patients had surgery. All four not having surgery died. Surgical survival was 13/25 (52%) at discharge and six months of follow up. Within the surgical group survival with prior thrombolytic therapy was 4/25 (25%) and 9/13 (69%) without (p=0.07). Conclusion There appears to be an earlier presentation of post-myocardial infarction VSD when thrombolytic therapy has been used. An early presentation can carry a worse prognosis and may have implications for the identification and treatment of this life threatening complication.
Procedural and 1‐month outcome data following implantation of the V‐Flex Plus stent in our first 54 consecutive patients (35 male; mean age, 62 years) are described. Sixty‐four stents were implanted for 60 mainly complex lesions; 48% were left anterior descending; 20%, circumflex; 27%, right coronary artery; and 5%, saphenous vein graft. The indication for stenting was elective in half of the patients and for a suboptimal result or as a bailout procedure in the other half. The stents were deployed at a mean of 12 atm (range, 6–18) and postdilated to a mean of 15 atm (range, 8–20). Pre‐ and postdilatation balloon sizes were 2.96 ± 0.57 mm and 3.16 ± 0.34 mm, respectively. The procedural success rate was 98%. There were no deaths or Q‐wave myocardial infarctions. One patient suffered a non–Q‐wave myocardial infarction and another developed a femoral false aneurysm. At 1‐month follow‐up, there were no additional events, in particular no revascularization procedures. Eighty‐nine percent of patients were free of angina. Implantation of the V‐Flex Plus stent is safe and effective with an excellent early success rate comparable to that of published randomized trials and registries of carefully selected patients. Cathet. Cardiovasc. Intervent. 47:504–508, 1999. © 1999 Wiley‐Liss, Inc.
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