Transcatheter Closure of Postinfarction Ventricular Septal Defects Using Amplatzer Devices

Białkowski, Jacek; Szkutnik, Małgorzata; Kusa, Jacek; Kalarus, Zbigniew; Gąsior, Mariusz; Przybylski, Roman; Banaszak, Paweł; Zembala, Marian

doi:10.1016/s1885-5857(07)60197-2

Cited by 20 publications

(28 citation statements)

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“…Forty four‐studies were identified of which 18 were excluded based on criteria previously stated. Twenty‐six studies were analyzed which included a total of 737 patients who underwent either primary TCC ( n = 291, 40%) as an early ( n = 176, 24%) or late ( n = 115, 16%) approach to treat PIVSD, post‐surgical residual VSD ( n = 79, 9.5%), only surgical closure ( n = 267,22%) as an early ( n = 167, 63%) or late surgical repair ( n = 100, 37%) or medical treatment alone group ( n = 100, 13.6%) …”

Section: Resultsmentioning

confidence: 99%

Management of post‐myocardial infarction ventricular septal defects: A critical assessment

Omar

Morgan

Panchal

et al. 2018

J Interven Cardiology

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Background: Post-myocardial infarction (MI) ventricular septal defects (PIVSD) are an uncommon but life-threatening complication of acute MI. Although surgical closure has been the standard of care, mortality, and recurrence of VSD remain high even after emergent surgery. Transcatheter VSD closure (TCC) devices have become an alternative or adjunct to surgical closure.Methods: Online database search was performed for studies that included adults with PIVSD who underwent medical treatment (MT) alone, surgical closure (SC) (early or late), and TCC (early, late, or for post-surgical residual VSD).Results: Twenty-six studies were included with a total of 737 patients who underwent either MT (N = 100), SC (early (n = 167), late (n = 100)), and TCC (early (n = 176), late (n = 115), or post-surgical residual VSD (n = 79)). The 30-day mortality among MT group was 92 ± 6.3%, among SC was 61 ± 22.5% (early 56 ± 23%, late 41 ± 30%), and for all TCC patients was 33 ± 24% (early 54 ± 32.7%, late 16 ± 26%), and TCC for post-surgical residual VSD 11 ± 34.9%. The mortality among overall SC, overall TCC and early TCC groups was significantly lower as compared with the MT (P < 0.001 for all comparisons).The overall mortality among all TCC, and late TCC groups was significantly lower when compared with the late SC (P < 0.0001, P < 0.0001, respectively). Conclusion: Closure of PIVSD decreases mortality as compared with MT alone and should be attempted as early as possible after diagnosis. Selection of TCC versus SC should be based on factors including complexity of the defect, availability of closure devices, expertise of the operator, and clinical condition of patient. K E Y W O R D S closure device, management, post-infarction VSD, transcatheter

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Section: Resultsmentioning

confidence: 99%

Management of post‐myocardial infarction ventricular septal defects: A critical assessment

Omar

Morgan

Panchal

et al. 2018

J Interven Cardiology

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“…5,[17][18][19][20][21][22]24,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] Most such patients underwent VSD closure in the chronic or subacute phase, or experienced residual shunting after surgical patch closure. 5 This summary presents the results of a prospective series in which all patients with post-MI VSDs were treated in the acute setting, whether or not they were in severe cardiogenic shock.…”

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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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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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“…When TCC is performed during an acute phase, Thiele et al 9 reported high mortality up to 65% as in surgically treated patients, but when done in the subacute phase Bialkowski et al 10 reported successful implantation in 73% and overall mortality of 26%. Timing of TCC of PIMVSD is one of the major determinants of outcome.…”

Section: Discussionmentioning

confidence: 99%

Challenges in treatment of postinfarction ventricular septal defect and heart failure

Mangovski¹,

Kozlik‐Feldmann

Perić³

et al. 2015

VOJNOSANIT PREGL

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Transcatheter Closure of Postinfarction Ventricular Septal Defects Using Amplatzer Devices

Cited by 20 publications

References 8 publications

Management of post‐myocardial infarction ventricular septal defects: A critical assessment

Management of post‐myocardial infarction ventricular septal defects: A critical assessment

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

Challenges in treatment of postinfarction ventricular septal defect and heart failure

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