Post-infarction ventricular septal rupture

Abstract

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.

Ventricular septal defect complicating myocardial infarction: A case of delayed percutaneous transcatheter closure

“…Studies have shown that most VSD occurs 3-5 days after AMI. 3 The patients receiving drug therapy alone have a median survival time of 5 days; more than 75% of patients die within 12 days after the onset of VSD symptoms, with 93.6% of 30-day mortality rate, and 96.2% of longterm mortality rate. 4 Therefore, based on the experience, the Closure of ventricular septal perforation is the key to the treatment of post-AMI VSD.…”

“…In our report, the patient did not seek medical treatment. Studies have shown that most VSD occurs 3–5 days after AMI 3 . The patients receiving drug therapy alone have a median survival time of 5 days; more than 75% of patients die within 12 days after the onset of VSD symptoms, with 93.6% of 30‐day mortality rate, and 96.2% of long‐term mortality rate 4 .…”

Interventricular Septal Rupture: An Uncommon Complication of an Acute Myocardial Infarction

“…Being the most common mechanical complication of MI [3], VSR is also one of the most lethal if left untreated, with a 50% survival rate after one week, 20% within one month and 10% within one year [1,3]. VSR is a consequence of loss of septal blood supply by branches derived from the left anterior descending artery from the left coronary and posterior interventricular branch from the right coronary (albeit in right dominant patients).…”

Post-infarction ventricular septal rupture complicated with cardiogenic shock and multiple organ hemorrhage: An autopsy case report

“…Post-myocardial infarction (MI) ventricular septal rupture (VSR) is a rare but potentially catastrophic mechanical complication [ 1 ], which specifically occurs in 0.21 % of patients with ST-segment elevation myocardial infarction (STEMI) and 0.04 % of patients with non-ST-segment elevation myocardial infarction (NSTEMI) [ 2 , 3 ]. Post-MI VSR is a medical emergency with a mortality rate of 70 %–80 % during the 2 weeks following diagnosis, and guidelines recommend urgent surgical closure irrespective of the patient's hemodynamic status [ 1 ].…”