The use of Impella Recover in the treatment of post-infarction ventricular septal defect: A new case report

Patanè, Francesco; Grassi, Rosario; Zucchetti, Martina; Ceresa, Fabrizio; Amata, Angelo Davide; Zingarelli, Edoardo; Sansone, Fabrizio; Marte, Filippo; Patanè, Salvatore

doi:10.1016/j.ijcard.2009.03.042

Cited by 19 publications

(11 citation statements)

References 11 publications

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“…75% of patients, the first week – approx. 50%, two weeks – 30%; only 4-15% of patients survive the first month [ 1 , 3 ]. These data and the dynamics of hemodynamic deterioration form arguments for expediting surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

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Post-myocardial infarction ventricular septal defect. Is it better to operate on a fresh infarction or to wait? A case study

Suder

Janik

Wasilewski

et al. 2016

kitp

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Section: Discussionmentioning

confidence: 99%

“…25 days from the myocardial infarction. Therefore, it appears desirable to strive for hemodynamic stabilization of the patient and delay the planned procedure in order to improve treatment conditions [ 2 , 3 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Post-myocardial infarction ventricular septal defect. Is it better to operate on a fresh infarction or to wait? A case study

Suder

Janik

Wasilewski

et al. 2016

kitp

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“…Early recognition of VSD can avoid clinical deterioration by early use of mechanical support to maintain haemodynamic stability5 and allow definitive lifesaving surgical intervention. The intra-aortic balloon pump works by counterpulsation that is, inflates in ventricular diastole and deflates in ventricular systole.…”

Section: Discussionmentioning

confidence: 99%

Acute ischaemic ventricular inferoseptal defect in a pyretic patient: a diagnostic challenge

Muscat

Laverse²,

Haq³

et al. 2011

Case Reports

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BACKGROUNDVentricular septal defect (VSD) is an important and often fatal consequence of myocardial infarction (MI). We present an atypical case of a postinfarct VSD with a late presentation. In the era of primary coronary intervention and advancements in peri MI therapy, the incidence of complications, such as VSD, has decreased signifi cantly. Delayed or indeed misdiagnosis can occur as a result of low clinical suspicion and an unfamiliarity with atypical presentations. This case serves as an important reminder of potentially fatal sequelae of MI and VSD, thus allowing for prompt recognition and early intervention. CASE PRESENTATIONA 78-year-old man presented with a 5-day progressive history of vomiting, dyspnoea and fever. He denied any history of chest pain. He had no signifi cant medical history or family history and was on no regular medications. He had smoked variable amounts of cigarettes in the past.On examination, he was febrile, tachycardic, hypotensive and peripherally cyanosed. There was a systolic murmur in the left lower sternal area. The patient deteriorated over 4 days with a multiple organ dysfunction syndrome and was managed in the critical care unit.

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“…Alternative mechanical circulatory support (MCS) devices have been used in small series for postinfarct VSD. These include Impella,27–29 TandemHeart30 and veno-arterial extra corporeal membrane oxygenation (VA-ECMO) 31 32. A computer simulation model to evaluate the effectiveness of different MCS devices for postinfarct VSD33 found that no device normalised haemodynamics, and the ratio of pulmonary to systemic flow (Qp:Qs ratio) could not be reduced below 2.0.…”

Section: Undertaking the Proceduresmentioning

confidence: 99%

Transcatheter treatment of postinfarct ventricular septal defects

Giblett

Jenkins

Calvert

2020

Heart

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Postinfarct ventricular septal defects (VSDs) are a mechanical complication of acute myocardial infarction (AMI) with a very poor prognosis. They are estimated to occur in 0.2% of patients presenting with AMI, with 1-month survival of 6% without intervention. Guidelines recommend surgical repair, but recent advances in transcatheter technology, and bespoke device development, mean it is increasingly viable as a closure option. Surgical mortality is between 30% and 50% for all-comers, while in series of transcatheter closure, mortality was 32%. Transcatheter closure appears durable, with no evidence of late leaks and low long-term mortality in series with up to 5-year follow-up. Guidelines recommend early closure, which is likely to provide most benefit for patients regardless of the closure method. Multimodality cardiac imaging including echocardiography, CT and cardiac MRI can define size, shape, location of defects and their relationship to other cardiac structures, assisting with treatment decisions. Brief delay to allow stabilisation of the patient is appropriate, but untreated patients risk rapid deterioration. Mechanical circulatory support may be helpful, although the preferred modality is unclear. Transcatheter closure involves large bore venous access and the formation of an arteriovenous loop (under fluoroscopic and trans-oesophageal echocardiographic guidance) in order to facilitate deployment of the device in the defect and close the postinfarct VSD. Guidelines suggest transcatheter closure as an alternative to surgical repair in centres where appropriate expertise exists, but decisions for all patients with postinfarct VSD should be led by the multidisciplinary heart team.

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The use of Impella Recover in the treatment of post-infarction ventricular septal defect: A new case report

Cited by 19 publications

References 11 publications

Post-myocardial infarction ventricular septal defect. Is it better to operate on a fresh infarction or to wait? A case study

Post-myocardial infarction ventricular septal defect. Is it better to operate on a fresh infarction or to wait? A case study

Acute ischaemic ventricular inferoseptal defect in a pyretic patient: a diagnostic challenge

Transcatheter treatment of postinfarct ventricular septal defects

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