Perforation of Interventricular Septum After Myocardial Infarction

Harrison, R. J.; Shillingford, John; Allen, Geoffrey T.; Teare, Dawn

doi:10.1136/bmj.1.5232.1066

Cited by 15 publications

(2 citation statements)

References 10 publications

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“…I n recent years further cases including several diagnosed ante mortem have been reported from Scandinavia (4,12,18,19,20,21,26,30,32) and other countries. Series of ruptures of the septum many of which were diagnosed before death have also been published (2,13,17,24,25,31). All these series, however, probably represent a certain selection.…”

mentioning

confidence: 99%

Perforation of the Interventricular Septum in Myocardial Infarction: A Study Based upon an Autopsy Material

Lundberg

Söderström

1962

Journal of Internal Medicine

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confidence: 99%

Perforation of the Interventricular Septum in Myocardial Infarction: A Study Based upon an Autopsy Material

Lundberg

Söderström

1962

Journal of Internal Medicine

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“…The most helpful clinical feature is the site of the murmur: the pansystolic murmur of an acquired septal defect, like that of the congenital lesion, is usually loudest at the lower left sternal border, and is often accompanied by a thrill (Sanders et al, 1956). However, since the defect is in the muscular septum, the murmur may be well heard at the apex and in the axilla (Harrison et al, 1961). The murmur of papillary muscle rupture is also pansystolic, but is usually, though not always, loudest at the apex, and is very rarely associated with a thrill; a diastolic murmur is quite common (Sanders, Neubuerger, and Ravin, 1957;Robinson, Stannard, and Long, 1965).…”

Section: Repair Of Acquired Ventricular Septal Defect After Myocardiamentioning

confidence: 99%

Successful early repair of acquired ventricular septal defect after myocardial infarction.

Honey¹,

Belcher²,

Hasan³

et al. 1967

Heart

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Successful repair of an acquired ventricular septal defect following myocardial infarction was first reported in 1962. Recently Barnard and Kennedy (1965) have reviewed 14 patients with post-infarction ventricular septal defect in whom surgical closure was attempted; 7 survived more than 6 weeks after operation. They found that those whose defects were closed 5 weeks or more after infarction survived the operation, but that those requiring emergency operation soon after infarction died. The best long-term results were obtained in those whose operations were delayed 3 months or more. However, more than 90 per cent of all patients die within a year of septal rupture, and most of these die within 2 months (Sanders, Kern, and Blount, 1956). It is clear that surgical repair should be considered in all patients who have a hemodynamically significant shunt through an acquired ventricular septal defect; ideally this should be done at least 6 and preferably 12 weeks after infarction, but, in view of the very high early mortality on medical treatment, nothing can be lost by attempting closure at an earlier stage if the patient is deteriorating.The following report concerns a patient in whom the defect was successfully repaired 27 days after infarction, and 20 days after the presumed time of septal rupture. Case ReportA man, aged 52, had left-sided chest pain, with nausea and sweating, on September 10, 1965. On September 17, he was more breathless and had a fainting episode; on this occasion his doctor heard a loud pracordial systolic murmur for the first time.On admission to the Whittington Hospital on September 20 under the care of Dr. T. St M. Norris, he was pale and sweating with a regular tachycardia and a raised venous pressure. The blood pressure was 120/100 453 mm. Hg. The heart was not clinically enlarged but a loud pansystolic murmur with thrill was loudest in the fourth left intercostal space near the sternum. There were bilateral basal rales, and a chest x-ray film showed pulmonary venous congestion with a small right pleural effusion. The electrocardiogram showed a recent posterior myocardial infarct. The diagnosis of ruptured interventricular septum was made; he improved at first on routine medical treatment, but signs of right-sided heart failure increased, and he was transferred to the London Chest Hospital on September 28 for consideration of surgical repair.At this time he was orthopnceic, and had signs of congestive cardiac failure with raised jugular venous pressure (10 cm.), enlarged tender liver, and cedema of both ankles. The pulse was rapid (110/min.) and the blood pressure 130/100 mm. Hg. The murmur and thrill were unchanged. He had several carious teeth and gross gingival infection. The chest x-rayfilm showed no cardiac enlargement (CTR 48%); there was severe pulmonary congestion with bilateral hilar and basal clouding and small pleural effusions. The electrocardiogram showed normal sinus rhythm; Q waves, slightly raised ST segments, and inverted T waves in leads II, III, aVF, V6, and V7 indicated...

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Systolic Murmur Developing After Myocardial Ischemia or Infarction

Holloway¹

1965

JAMA

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Perforation of Interventricular Septum After Myocardial Infarction

Cited by 15 publications

References 10 publications

Perforation of the Interventricular Septum in Myocardial Infarction: A Study Based upon an Autopsy Material

Perforation of the Interventricular Septum in Myocardial Infarction: A Study Based upon an Autopsy Material

Successful early repair of acquired ventricular septal defect after myocardial infarction.

Systolic Murmur Developing After Myocardial Ischemia or Infarction

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