Surgical repair of post infarction ventricular septal defects: a national experience☆

Jeppsson, Anders; Lidén, Hans; Johnsson, Per; Hartford, Marianne; Rådegran, Kjell

doi:10.1016/j.ejcts.2004.10.037

Cited by 155 publications

(167 citation statements)

References 14 publications

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“…4,5 However, mortality rates remain high after surgical intervention, ranging from 20% to 87%, depending on severity in the individual patient and on length of follow-up. [5][6][7][8][9][10][11] Because surgery offers a better outcome than medical management alone, immediate surgical intervention is now a class I recommendation for post-MI VSD. 12,13 However, early surgical repair can be difficult because of the soft and friable tissue surrounding the area of infarction and the possibility of VSD expansion.…”

mentioning

confidence: 99%

Percutaneous Repair of Post-Myocardial Infarction Ventricular Septal Defect: Current Approaches and Future Perspectives

Baldasare¹,

Polyakov²,

Laub³

et al. 2014

Texas Heart Institute Journal

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Post-myocardial infarction ventricular septal defect is a devastating complication of STelevation myocardial infarction. Although surgical intervention isT he occurrence of a ventricular septal defect (VSD) after a myocardial infarction (MI) is an infrequent but serious sequela, which usually occurs within the first week.1 In the years before reperfusion became available, the incidence of VSD after an MI was between 1% and 2%, with an in-hospital mortality rate of 45% with surgery, and 90% with medical management alone.1-4 After the introduction of reperfusion therapy, the rate of post-MI VSD decreased to 0.2% to 0.34%. 4,5 However, mortality rates remain high after surgical intervention, ranging from 20% to 87%, depending on severity in the individual patient and on length of follow-up. 5-11Because surgery offers a better outcome than medical management alone, immediate surgical intervention is now a class I recommendation for post-MI VSD. 12,13 However, early surgical repair can be difficult because of the soft and friable tissue surrounding the area of infarction and the possibility of VSD expansion.14-16 In addition, a residual shunt persists in 10% to 37% of patients despite surgical repair; 11% of those residual defects need further surgical procedures. 7 An approach that would enable immediate hemodynamic stabilization and closure of the defect is desirable. Although transcatheter closure of a post-MI VSD is relatively new, investigators have shown that this procedure is well suited for treating residual shunts after surgical closure and for stabilizing critically ill patients as a bridge to future surgery. [17][18][19][20][21][22][23] We report our experience with 2 cases of the percutaneous closure of post-MI VSDs, which illustrate these principles. Case Reports Patient 1Transcatheter Closure of Recurrent Shunt after Surgical Repair. A 65-year-old man presented at our institution's emergency department with chest pain and shortness of breath. On physical examination, the patient exhibited signs of congestive heart failure, together with a grade 3/6 harsh holosystolic murmur. The patient was hypotensive, his cardiac enzymes were elevated, and electrocardiographic findings showed ST-elevation in the anterior leads. An echocardiogram revealed a VSD, an akinetic anterior wall, and a hyperdynamic posterior wall. Cardiac catheterization showed critical left main and multivessel coronary artery disease. The patient's pulmonary artery (PA) pressure was 42/22 mmHg, there was an oxygen elevation in the right ventricle (RV), and his PA oxygen saturation was 79%. The Qp/Qs was 2.2:1.The patient underwent successful coronary artery bypass grafting (CABG), together with Dacron-graft repair of the VSD. One week postoperatively, he developed increasing dyspnea and had a recurrent holosystolic murmur. He was found on echocardiography to have a residual VSD (Fig. 1). Repeat angiography showed 2 defects,

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confidence: 99%

Percutaneous Repair of Post-Myocardial Infarction Ventricular Septal Defect: Current Approaches and Future Perspectives

Baldasare¹,

Polyakov²,

Laub³

et al. 2014

Texas Heart Institute Journal

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“…По дан-ным литературы госпитальная летальность при хирурги-ческом закрытии дефекта составляет 23-81% [2,15,16]. Высокая летальность после подобных операций обус-ловлена исходной тяжестью оперируемых больных, пожилым возрастом пациентов, тяжелой сопутствую-щей патологией, а также нередкими техническими про-блемами хирургической процедуры [17].…”

Section: Discussionunclassified

Endovascular treatment of postinfarction ventricular septal defects

Khelimskii¹,

Крестьянинов²,

Осиев³

et al. 2016

Patol krovoobrashch kardiokhir

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Aim: The study was designed to evaluate the possibility and safety of transcatheter closure of postinfarction ventricular septal defects in different periods after acute myocardial infarction. Methods: Over a period from 2010 to 2015 15 patients (11 females and 4 males) underwent transcatheter closure of postinfarction ventricular septal defects. The time from the onset of infarction to the intervention varied between 1 day and 6 months (mean 10.9 weeks). Three patients were treated in an acute phase of infarction (two weeks or less). The defect size ranged 7-24 mm (mean 13.5 mm), while the implanted devices sized 12-34 mm (mean 22.8 mm). The procedure and screening time amounted to 67-170 (mean 115.3) and 14-78 (mean 32.5) minutes respectively. Results: A successful device implantation occurred in all but one patient whose occluder was dislodged. This patient later underwent successful surgical VSD closure. Occluder implantation failed to improve the clinical status of two patients in a critical condition. They developed multiple organ failure and died at 2 and 9 days after the procedure. Conclusion: Transcatheter closure of postinfarction ventricular septal defects may be an alternative to surgery in patients with suitable anatomy and multiple comorbidities. However, in-hospital mortality remains high, even after successful occluder implantation.

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“…Nosotros lo usamos en 61% de los pacientes. Igualmente, la localización anterior del defecto fue el más frecuente [15][16][17] . La técnica quirúrgica de exclusión de la comunicación y de la zona infartada con un parche de pericardio bovino descrita por David, es la más utilizada en la actualidad 18 .…”

Section: Discussionunclassified

“…El número de puentes fue 1,8/paciente, mayor que lo publicado. Probablemente, ésto traduce la tendencia a no revascularizar la zona infartada, lo que sólo se efectuó en el 47% de los casos [15][16][17] . Las publicaciones más recientes no comunican rotura del ventrículo izquierdo asociada a la CIVPI, que en nuestra serie se presentó en 4 pacientes.…”

Section: Discussionunclassified

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Cirugía de la comunicación interventricular post infarto: análisis de los últimos 22 años

et al. 2014

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Introducción: El desarrollo de una comunicación interventricular en la evolución de un infarto miocárdico es una complicación muy grave, aunque infrecuente.Objetivo: Comunicar nuestros resultados con el tratamiento quirúrgico de pacientes con comunicación interventricular post infarto (CIVPI) intervenidos en los últimos 22 años.Método: Analizamos en forma retrospectiva los antecedentes de los pacientes intervenidos entre Enero de 1991 y Diciembre de 2012. Revisamos fichas clínicas, protocolos operatorios y certificamos la mortalidad con el Registro Civil e Identificación de Chile.Resultados: Operamos 43 pacientes, edad promedio de 66,6 ± 10,2 años. El 58% eran hombres, de menor edad que las mujeres (63,1 ± 10,8 vs 71,5 ± 6,9 años, p=0,006). El tiempo promedio entre el diagnóstico de infarto y de CIVPI fue 10 ± 15 días. El 74% fueron intervenidos de urgencia. La CIVPI fue anterior en 58%. Se realizó revascularización miocárdica concomitante en el 58%. Trece pacientes fallecieron (30%) en el posoperatorio. Factores de riesgo de mortalidad operatoria fueron: cirugía de urgencia ( p = 0,019]) y uso de balón intra aórtico (p = 0,006). La cirugía realizada después de las 24 horas del diagnóstico tuvo una mortalidad significativamente menor (7,7%, p=0,033). El seguimiento promedio fue de 8,36 ± 5,3 años. La supervivencia alejada, excluida la mortalidad operatoria, a 5 y 10 años, fue 93% y 71%, respectivamente.Conclusión: La CIVPI tiene elevada mortalidad operatoria, especialmente en pacientes intervenidos de urgencia y en los que requirieron balón de contra pulsación, pero la supervivencia alejada de los sobrevivientes es muy satisfactoria.

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Surgical repair of post infarction ventricular septal defects: a national experience☆

Cited by 155 publications

References 14 publications

Percutaneous Repair of Post-Myocardial Infarction Ventricular Septal Defect: Current Approaches and Future Perspectives

Percutaneous Repair of Post-Myocardial Infarction Ventricular Septal Defect: Current Approaches and Future Perspectives

Endovascular treatment of postinfarction ventricular septal defects

Cirugía de la comunicación interventricular post infarto: análisis de los últimos 22 años

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