Anesthesia for repair of ventricular septal rupture after acute myocardial infarction

Iida, Ryoji; Kajiwara, Keizo; Saeki, Shigeru; Ogawa, Setsuro

doi:10.1016/j.jclinane.2006.11.007

Cited by 2 publications

(2 citation statements)

References 17 publications

(25 reference statements)

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“…Most important concerns in anesthetic management of VSR are to reduce LV afterload and to optimize systemic blood pressure at the same time. 4 Further, reduction in afterload is needed to prevent deterioration of the shunt during the pre-bypass period and in the post-bypass period, to prevent tension to the newly repaired septal wall. 4 To fulfil these requirements, intravenous nitroglycerin infusion was used in addition to adrenaline infusion for our patient.…”

Section: Discussionmentioning

confidence: 99%

“…4 Further, reduction in afterload is needed to prevent deterioration of the shunt during the pre-bypass period and in the post-bypass period, to prevent tension to the newly repaired septal wall. 4 To fulfil these requirements, intravenous nitroglycerin infusion was used in addition to adrenaline infusion for our patient. Nitroglycerin has been shown to reduce LV afterload.…”

Section: Discussionmentioning

confidence: 99%

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Transesophageal Echocardiographic Illustration of Postinfarction Ventricular Septal Rupture

Das

Prakash

Makhija

2022

Journal of Cardiac Critical Care TSS

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Postinfarction ventricular septal rupture (VSR) is a rare but dreaded mechanical complication of myocardial infarction. Moreover, patient develops cardiogenic shock or congestive heart failure requiring early surgical intervention. To optimize surgical repair, perioperative confirmation, determining location of VSR and adequacy of repair, is mandatory. Assessment can be obtained by the transesophageal echocardiography (TEE). Use of two- and three-dimensional TEE techniques clearly delineate size and shape of septal rupture and involvement of other cardiac structures. We report a patient presenting with postinfarction VSR for elective VSR repair and surgical revascularization and implication of TEE in perioperative management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transesophageal Echocardiographic Illustration of Postinfarction Ventricular Septal Rupture

Das

Prakash

Makhija

2022

Journal of Cardiac Critical Care TSS

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Perioperative Risk Assessment for Surgery of Consecutive Cases with Ventricular Septal Rupture: Seeking A Novel and Comprehensive Method

Wang

Hai

Feng

et al. 2021

HSF

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Background: Ventricular septal rupture (VSR) is a rare but lethal complication occurring after acute myocardial infarction. The aim of our study was to review the single-center experience of surgery for VSR and seek a comprehensive evaluation process for early mortality. Methods: Patients undergoing surgical repair for postinfarction VSR in our institution retrospectively were evaluated from Jan. 2006 to Dec. 2019. The endpoint of the study was mortality within 30 days after VSR surgery, which was divided into survivors and nonsurvivors. The calibration and discrimination of two risk evaluation systems (European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) risk score) in total were compared by Hosmer-Lemeshow, and the area under the receiver operating characteristic curve (AUC). Risk factors in subsets were assessed by logistic regression analysis. Results: Twenty-three patients undergoing surgery for VSR repair were reviewed, and the early mortality after surgery was 34.8% (N = 8). The expected mortality predicted by EuroSCORE II was 24.3%, and that of the STS score was 12.2%. Both the EuroSCORE II and STS risk evaluation systems showed positive calibration in predicting mortality (H-L: P = 0.117 and P = 0.346, respectively) but poor discriminative power (AUC=0.633 and 0.575). Significant predictors determined by univariate analysis were concomitant coronary artery bypass grafting (CABG) (P = 0.035) and postoperative continuous renal replacement therapy (CRRT) (P = 0.008). Conclusion: Early mortality of VSR after surgery remains high, and the evaluation process is complicated. The performances of the two risk evaluation systems were not optimal, but EuroSCORE II was more accurate than STS. Patients with lower preoperation EuroSCORE II, concomitant CABG during repair, and no need for CRRT after surgery may have a better early survival rate.

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Anesthesia for repair of ventricular septal rupture after acute myocardial infarction

Cited by 2 publications

References 17 publications

Transesophageal Echocardiographic Illustration of Postinfarction Ventricular Septal Rupture

Transesophageal Echocardiographic Illustration of Postinfarction Ventricular Septal Rupture

Perioperative Risk Assessment for Surgery of Consecutive Cases with Ventricular Septal Rupture: Seeking A Novel and Comprehensive Method

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