Left ventricular approach for the repair of ventricular septal perforation and infarctectomy

Javid, Hushang; Hunter, James A.; Najafi, Hassan; Dye, William S.; Julian, Ormand C.

doi:10.1016/s0022-5223(19)41953-3

Cited by 46 publications

(6 citation statements)

References 25 publications

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“…found that the right ventricular approach might be associated with the risks of residual shunt–due to irregular trabeculae in the right ventricle–and decreased right ventricular function. Besides, it has been suggested that post-MI patients with VSP are at risk for left ventricular free wall rupture as well [5] . The left ventricular approach not only prevents free wall rupture but also offers the advantage of feasibility because the trabeculae in the left ventricle are dense.…”

Section: Discussionmentioning

confidence: 99%

Treatment of ventricular septal perforation caused by blunt trauma using the right ventricle approach: A case report

Yamasawa

Kanaoka

Furusawa

et al. 2021

Journal of Cardiology Cases

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Traumatic ventricular septal perforation (VSP) is a rare condition that can occur following chest trauma and can lead to heart failure. Herein, a case of VSP caused by blunt chest trauma successfully closed using the double-patch technique via the right ventricle after medial sternotomy is presented. This case report highlights the necessity of emergency surgery in the acute phase of traumatic VSP if heart failure is difficult to control. This technique was useful for acute surgery. < Learning objective: Traumatic ventricular septal perforation (VSP) can occur following chest trauma. The timing of surgery depends on the severity of heart failure and the urgency of other traumas. Since the left ventricular pressure is higher than the right ventricular pressure, complete hemostasis of the left ventricle is difficult. Hence, traumatic VSP might be successfully approached and closed via the right ventricle. Here we report a successful closure of traumatic VSP after blunt chest trauma using the right ventricular approach through medial sternotomy.>

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Section: Discussionmentioning

confidence: 99%

Treatment of ventricular septal perforation caused by blunt trauma using the right ventricle approach: A case report

Yamasawa

Kanaoka

Furusawa

et al. 2021

Journal of Cardiology Cases

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“…Cooley and colleagues reported the first case treated with surgery using an approach through the right ventricular outflow tract (11). This approach does not offer adequate exposure of all parts of the septum and a few years later, most surgeons adopted an incision through the infarcted left ventricle (12). The location and length of the incision depends on where the defect is: apical, anterior or posterior septum.…”

Section: Surgical Treatment Of Post-infarction Ventricular Septal Wall Rupturementioning

confidence: 99%

Post-infarction ventricular septal rupture

David¹

2022

Ann Cardiothorac Surg

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Coronary reperfusion therapies have led to a reduction in the incidence of mechanical complications of acute myocardial infarction (AMI), but the associated mortality of these complications has remained high.Ventricular septal rupture is the most common mechanical complication after myocardial infarction and occurs in approximately 0.21% with ST-segment elevation myocardial infarction and in 0.04% with non-ST-segment elevation myocardial infarction. Surgery is the only definitive treatment but it is associated with high operative mortality and morbidity and, in some centers, alternative treatment with mechanical support of circulation and trans-catheter closure of the defect is being used. We continue to believe that immediate surgery offers the best opportunity for long-term survival. Patients should be taken directly to the operating room or via the heart catheterization laboratory if the coronary artery anatomy is unknown. This should be done as soon as the diagnosis is made, as acute rupture of the interventricular septum is a surgical emergency.The operative technique of infarct exclusion has been our preferred method and when performed in hemodynamically stable patients, the operative mortality is around 10%, although much higher in patients in cardiogenic shock. Patch dehiscence and persistent shunts are uncommon after closure of the defect using this technique. Delaying operative intervention in hemodynamically stable patients frequently leads to cardiogenic shock and multi-organ failure. Transcatheter closure of these acute septal lesions is complex, not necessarily feasible in all patients, and there is no evidence that the results are superior to surgery.

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“…These techniques addressed many of the deficiencies of a RVOT approach [22]. The benefits of these animal studies were subsequently validated clinically within several years [26][8]…”

Section: Operative Managementmentioning

confidence: 99%

Management And Controversies of Post Myocardial Infarction Ventricular Septal Defects

Firstenberg¹,

Kissling²,

Nelson³

2013

Principles and Practice of Cardiothoracic Surgery

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Addi"ional informa"ion is available a" "he end of "he chap"er h""p://dx.doi.org/10.5772/53396. Introduction "cute myocardial infarction "MI , despite advances in health care delivery systems, education, and primary prevention still remains a significant problem. Fortunately, with these advances and early interventions, there has been a decline in the incidence of mechanical complications. Unfortunately, while becoming less common, when mechanical complications occur and despite advances and evolving techniques in the surgical management of these problems, morbidity and mortality remain high. Post-myocardial infarction ventricular septal rupture PI-VSD has challenged and intrigued clinicians for years. The timing of presentation can be quite variable, as they tend to occur in patients several days after their initial cardiovascular insult acute PI-VSD -and unfortunately, they can occur in patients who appear to otherwise be doing well. In addition, while less common, some patients might not present until weeks, if not longer, after their "MI with symptoms prompting a work-up that might reveal a chronic PI-VSD. Early PI-VSDs tend to be catastrophic and can result in death. The pathology is also variable and complex, but common themes include . acute right ventricular RV failure from a sudden increase in pressure, volume, and flow from left to right shunts,. pulmonary hypertension also from the acute increase in RV work and flow and . worsening cardiac output, often with manifestations of shock and end-organ damage, from acute left ventricular LV dysfunction and left-right shunting.Definitive management remains surgical, however, controversies continue to exist regarding the timing of surgery, the role of concomitant coronary revascularization, and the evolving © 2013 Firs"enberg e" al.; licensee InTech. This is an open access ar"icle dis"rib""ed "nder "he "erms of "he Crea"ive Commons A""rib""ion License (h""p://crea"ivecommons.org/licenses/by/3.0), which permi"s "nres"ric"ed "se, dis"rib""ion, and reprod"c"ion in any medi"m, provided "he original work is properly ci"ed.role of percutaneous closure devices. Unfortunately, despite early repair and improvement in techniques and peri-operative management, the short and long-term outcomes remain less than ideal. . HistoryPost-myocardial infarction ventricular septal defects PI-VSD were described first at autopsy [ ]. It was not until that the pre-mortem pathophysiology was understood [ ]. [ ], described the association with coronary artery disease and acute myocardial infarction [ ].The first report of a surgical repair came in when Denton Cooley described a patient weeks after the initial diagnosis who underwent operative intervention [ ]. With advances in the peri-operative and intra-operative management of the cardiovascular surgery patients there were reports of survival in what was previously felt to be an inherently fatal problem. Most of the successful operative cases occurred in patients who presented in congestive heart failure weeks after their initial acute...

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Left ventricular approach for the repair of ventricular septal perforation and infarctectomy

Cited by 46 publications

References 25 publications

Treatment of ventricular septal perforation caused by blunt trauma using the right ventricle approach: A case report

Treatment of ventricular septal perforation caused by blunt trauma using the right ventricle approach: A case report

Post-infarction ventricular septal rupture

Management And Controversies of Post Myocardial Infarction Ventricular Septal Defects

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