Ventricular septal defect: early against late surgical repair

Abstract

Ventricular septal defect (VSD) is a rare complication of right ventricular infarction (RVI) which is associated with significant mortality, if not treated appropriately. It typically occurs within the first 10–14 days after myocardial infarction. Surgical repair has been shown to reduce in-hospital mortality from 90% to 33–45%. Early surgical VSD repair has also been associated with high 30-day operative mortality of 34–37%. Furthermore, after an acute MI the friable myocardium enhances the risk of recurrent VSD with early surgical repair. We present a case of a middle-aged woman who developed VSD after an RVI. Her surgical repair was delayed by 2 weeks due to development of Staphylococcus aureus bacteremia. During this period, she was managed medically and later on underwent percutaneous repair with an amplatzer VSD occluder device. Keeping this patient encounter in mind, we would like to emphasize on the limited recommendations available for early against late surgical repair of VSD.

Short- and medium-term follow-up of transcatheter closure of perimembranous ventricular septal defects

“…For valve regurgitation, valve insufficiency is associated with the use of an oversized occluder or an insufficient distance from the occluder edge to the valve. A left ventricular disc diameter of the occluder exceeding 50% of the circumference of the subaortic outflow tract has been reported to lead to outflow tract deformation, and thus to valve insufficiency [12]. Therefore, the position and distance between each valve and the defect should be carefully assessed preoperatively using echocardiography.…”

Influence of percutaneous catheter intervention for congenital perimembranous ventricular septal defects in children on the cardiac conduction system and associated risk factors: a meta-analysis

“…Valve regurgitation is associated with using an oversized occluder or an insufficient distance between the occluder edge and the valve. A diameter of the left ventricular disc of the occluder exceeding 50% of the circumference of the inferior aortic outflow tract has been reported to lead to outflow tract deformation and valve dysfunction [25]. A total of 13 patients had reflux before operation.…”

A Rare Complication of Myocardial Infarction: Ventricular Septal Defect

“…The subacute course which occurs within a week after myocardial infarction is the result of a cascade of pathological events that starts with ischemia of the myocardium then coagulative necrosis then neutrophilic infiltration with subsequent macrophages infiltration and removal of necrotic tissue leading to the weakening of the tissue culminating in complications such as a ventricular free wall rupture, interventricular septum rupture, or a papillary muscle rupture. A much rarer type can occur >2 weeks following perforation of thinned aneurysmal myocardium [4].…”

“…Cardiogenic shock is an independent predictor of in-hospital mortality. These patients often require mechanical circulatory support [4]. In-hospital mortality is about 45% in patients who were surgically treated compared to 90% who were medically treated [2].…”

“…Multiple observational studies identified severe risk factors that increase the risk of cardiac rupture, including rupture of the interventricular septum, first incidence of MI, ST-segment elevation, female sex, previous stroke, positive initial cardiac biomarkers, older age (>70), and higher heart rate. On the other hand, a history of MI with primary percutaneous coronary intervention (PCI) and the use of low-molecular-weight heparin and beta-blockers during the first 24 hours were identified as protective factors for cardiac rupture [ 4 - 7 ].…”