Ventricular Septal Rupture – A Critical Condition as a Complication of Acute Myocardial Infarction

Novák, Martin; Hlinomaz, Ota; Groch, Ladislav; Rezek, Michal; Seménka, Jiří; Sikora, Jiri; Sitar, Jan

doi:10.1515/jccm-2015-0030

Cited by 7 publications

(10 citation statements)

References 25 publications

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“…The dissection of an intramural hemorrhage into ischemic myocardial tissue is probably leads to the occurrence of VSR in the first 24 h after the onset of MI. The surrounding tissue may be retracted subsequently and enlarge defect in the following weeks [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction

Shafiei¹,

Jannati²,

Jannati³

2020

Journal of the Saudi Heart Association

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Ventricular septal rupture (VSR) is an uncommon complication of myocardial infarction (MI). The mortality rate of VSR is high. The management of VSR is including the stabilization of the hemodynamic status and surgical closure of the rupture. In spite of the agreement of experts on the necessity of surgical repair, the timing of VSR repair management remains unclear. In this review article, we evaluate the optimal time repair of VSR. To collect the data, Pubmed, EMBASE, and Cochrane Central Registry databases were searched for potentially suitable studies. Search terms were including “Ventricular Septal Rupture”, “Myocardial Infarction”, “Timing”, and “MI”. According to the result of the studies, it seems that the time between VSR detection and its repair is a determining factor in the survival or mortality of patients in post-myocardial infraction VSR. Studies showed that earlier surgical repair in VSR increases the risk of mortality, because in the early phase after MI, infarcted myocardium is very fragile, and it is very difficult surgical repair and increases the risk of recurrent septal defects. The longer time is needed for the heart and different body systems to adapt to the hemodynamic results of the abrupt left to right shunt. It seems that the best time for the operation is after the maturation of VSR with scarring at the edges of the defect. Moreover, in a large number of patients, it is not possible to delay the operation since they are at risk of severe heart failure and organ dysfunction. In these cases operation immediately after diagnosis of VSR is recommended to prevent further hemodynamic deterioration. In hemodynamically compromised patients, it may be considered to use a ventricular assist device, requiring an intra-aortic balloon pump (IABP), or extracorporeal membrane oxygenation (ECMO) preoperative to postpone the operation which leads to higher survival in post-MI-VSD.

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Section: Introductionmentioning

confidence: 99%

Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction

Shafiei¹,

Jannati²,

Jannati³

2020

Journal of the Saudi Heart Association

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“…The occurrence of VSR complicating anterior myocardial infarction accounts for about 60%, and the occurrence complicating inferior myocardial infarction accounts for 40% [ 20 ]. Immediately after VSR, tissues surrounding the rupture site are retracted, friable, and defective [ 21 ]. Prognosis tends to be poor after early repair, and improves significantly if the intervention is deferred by 2 weeks or longer due to the maturation of the VSR, recovery of myocardial function, establishment of collateral blood supply, and adaption to hemodynamic changes [ 7 , 12 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Transcatheter closure of ventricular septal rupture with prolonged support of intra-aortic balloon pump after primary PCI: a case report

Yang

Sun

Zou

et al. 2021

BMC Cardiovasc Disord

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Background Ventricular septal rupture (VSR) is a rare but severe complication of acute myocardial infarction (AMI). For such cases, surgical repair is recommended by major guidelines, but not always possible for such cases. Case presentation A 72-year-old man presented to the emergency room. ECG showed the ST-segment was elevated by 2–3 mm in lead II, III, and aVF, with Q-waves. Coronary angiography (CAG) showed multi-vessel disease with a total occlusion of the right coronary artery (RCA) and severe stenosis of the left anterior descending artery (LAD). A diagnosis of acute inferior myocardial infarction was made. VSR occurred immediately after percutaneous coronary intervention (a 2.5 × 20 mm drug-eluting stent implanted in RCA), and the patient developed cardiogenic shock. An intra-aortic balloon pump (IABP) was used to stabilize the hemodynamics. Transthoracic echocardiography (TTE) revealed an 11.4-mm left-to-right shunt in the interventricular septum. An attempt was made to reduce the IABP augmentation ratio for weaning on day 12 but failed. Transcatheter closure was conducted using a 24-mm double-umbrella occluder on day 28. The patient was weaned from IABP on day 31 and underwent secondary PCI for LAD lesions on day 35. The patient was discharged on day 41. Upon the last follow-up 6 years later, CAG and TTE revealed no in-stent restenosis, no left-to-right shunt, and 51% left ventricular ejection fraction. Conclusions Prolonged implementation of IABP can be a viable option to allow deferred closure of VSR in AMI patients, and transcatheter closure may be considered as a second choice for the selected senior and vulnerable patients, but the risk is still high.

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“…Factors contributing to a worsening prognosis include right ventricular dysfunction, cardiogenic shock, multiple organ failure, and severity of the VSR. 13 If surgery is delayed or the patient presents to the hospital for emergency after 7 days post-MI, surgical mortality rates are 18.4%. 12…”

Section: Discussionmentioning

confidence: 99%

The Role of Echocardiography in the Assessment of Ventricular Septal Rupture Postmyocardial Infarction

Rampoldi

Kallstrom

2017

Journal of Diagnostic Medical Sonography

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Ventricular septal rupture (VSR) is a rare life-threatening mechanical complication secondary to acute myocardial infarction that usually occurs 2 to 8 days after infarction and frequently precipitates cardiogenic shock. The mortality rate for VSR has been reported to be between 41% and 80%; therefore, immediate surgical intervention should be considered. Furthermore, VSR is a complication of 0.17% to 0.31% of patients who present with an anterior myocardial infarction. Because of the rarity of this pathology, the role of transthoracic echocardiographic investigation will help to improve what is already considered a poor prognosis for these types of patients. This case study illustrates how transthoracic echocardiography plays an essential role in the rapid assessment and diagnosis of VSR in clinical practice.

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Ventricular Septal Rupture – A Critical Condition as a Complication of Acute Myocardial Infarction

Cited by 7 publications

References 25 publications

Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction

Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction

Transcatheter closure of ventricular septal rupture with prolonged support of intra-aortic balloon pump after primary PCI: a case report

The Role of Echocardiography in the Assessment of Ventricular Septal Rupture Postmyocardial Infarction

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