scholarly journals Post-myocardial infarction ventricular septal rupture in a patient with large secundum atrial septal defect: a case report

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Shabir Hussain Shah ◽  
Muhammad Azam Shah
Keyword(s):  
Myocardial Infarction ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Post Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Ventricular Septal Rupture ◽  
Secundum Atrial Septal Defect ◽  
Ventricular Ejection Fraction

Abstract Background Ventricular septal rupture (VSR) is an uncommon but potentially fatal complication of acute myocardial infarction (AMI). The management of VSR is challenging, and its surgical correction is associated with the highest mortality among all cardiac surgery procedures. Case summary A 57-year-old man with a history of smoking presented with AMI with a large apical VSR in addition to a large secundum atrial septal defect (ASD). His left ventricular ejection fraction was 30%, and the right ventricle was moderately dilated with normal systolic function. Cardiac catheterization revealed that the left anterior descending artery was diffusely diseased with total mid occlusion, whereas other coronary arteries had non-obstructive disease. This unique combination resulted in distinctive presentation with paradoxically better outcomes. After stabilization, the patient’s interventricular septum was reconstructed, and the ASD was closed with a pericardial patch. The post-operative period was uneventful, and the patient was discharged 1 week after surgery. A follow-up echocardiography revealed no residual shunt. Discussion Post-myocardial infarction VSR presents differently in patients with pre-existing right ventricular volume overload. In such cases, the absence of significant cardiogenic shock at presentation may result in better surgical outcomes.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chuan Yang ◽  
Yong Sun ◽  
Deling Zou ◽  
Zhaoqing Sun ◽  
Xinzhong Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Transcatheter Closure ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Drug Eluting Stent ◽  
Ventricular Septal Rupture ◽  
Total Occlusion ◽  
Ventricular Ejection Fraction ◽  
Intra Aortic Balloon Pump

Abstract 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.

scholarly journals Prevention of left ventricular remodeling after myocardial infarction: efficacy of physical training

2016 ◽  
Vol 70 (2) ◽  
Author(s):  
Camillo Taglieri ◽  
Enrico Lombardo ◽  
Mauro Feola
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Physical Training ◽  
Angiotensin Receptor Blockers ◽  
Left Ventricular ◽  
Post Myocardial Infarction ◽  
Cardiac Remodelling ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Positive Effect

Post-myocardial infarction left ventricular remodelling should be considered an important therapeutic target in patients after an acute myocardial infarction, considering the heavy prognostic implication. The therapies used in these patients should reduce the progression of the left ventricular dysfunction to refractory heart failure. In order to prevent post-myocardial infarction cardiac remodelling, different therapies have been tested, and for ACE-inhibitors and betablockers a clear demonstration of efficacy has been obtained. Losartan and valsartan, two widely used angiotensin receptor blockers, demonstrated to be safe and equally useful compared to ACEI. The addition of spironolactone to the standard therapy for heart failure has a clear beneficial effect but the clinical use has been refrained by the risk of iperkaliemia. Aerobic physical training improves the left ventricular ejection fraction in patients with systolic dysfunction, reducing the progressive enlargement after myocardial infarction. The positive effect of aerobic training on cardiac remodelling might be related to the positive effect on neurhormonal assessment, to he improvement of microcirculatory myocardial perfusion and of endothelial function.

scholarly journals Brain-derived neurotrophic factor gene polymorphism in post-ST-elevation myocardial infarction patients undergoing primary percutaneous intervention

2020 ◽  
Vol 7 (8) ◽  
pp. 3921-3932
Author(s):  
Olga V. Petyunina ◽  
Mykola P. Kopytsya ◽  
Alexander E. Berezin
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Post Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Syntax Score ◽  
Bdnf Gene ◽  
Cardiac Events ◽  
End Points ◽  
Ventricular Ejection Fraction

Introduction: The goal of this study was to elucidate a link of brain-derived factor (BDNF) Val66Met gene with combined 6-month clinical end points in post-myocardial infarction patients. Methods: 256 post-myocardial infarction patients who underwent primary coronary intervention were enrolled in the study. Variants of Val66Met gene BDNF were identified by real-time chain reaction at baseline. Results: The combined clinical end points (major cardiovascular events and hospitalization) were determined in 61 (23.8%) post-STEMI patients; consequently, 195 (76.2%) patients did not meet the events. linear regression revealed that predictors for combined clinical end points were peak TnI levels, NT-proBNP, SYNTAX score, TIMI score, obesity, left ventricular ejection fraction, and 66ValMet+66MetMet in BDNF gene. The cumulative clinical outcomes (major adverse cardiac events and admission) were determined in 61 (23.8%) patients. Kaplan-Meier curves demonstrated that 66ValVal of BDNF gene was significantly associated with the low number of combined end points. Conclusion: The Val66Met in BDNF gene independently predicted 6-month combined clinical end points in post-myocardial infarction patients.

Sign in / Sign up

Export Citation Format

Share Document