scholarly journals Ventricular Septal Rupture following Anterior Acute Myocardial Infarction: A Challenge to a Sub-District Physician

2021 ◽  
Vol 7 (1) ◽  
pp. 48-53
Author(s):  
Aditya Doni Pradana ◽  
Jarot Widodo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Rare Complication ◽  
Hemodynamic Instability ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
Anterior Myocardial Infarction ◽  
Mortality And Morbidity ◽  
Mechanical Complications ◽  
Resource Setting

Background: Ventricular septal rupture (VSR) is one of the most serious mechanical complications following acute myocardial infarction (AMI). Although a rare complication, it is associated with significant mortality and morbidity. The purpose of this report was to present a case of VSR following anterior AMI in our hospital. Case Description: A 54-year old Javanese male presented persistent episode of breathlessness and lower limb swelling for the last two days with prior chest pain 7 days ago. Physical examination revealed a grade 3/6 holosystolic murmer loudest over the apex, S3 gallop, rales bibasally of the lung. Electrocardiographic evidence revealed for a recent anterior myocardial infarction. Chest X-Ray showed a cardiomegaly and pulmonary congestion. Transthoracic echocardiography revealed VSR at mid-anteroseptal with estimated length of 8-10 mm, preserved LVEF 51% with mid-apicoseptal akinesis. Multiple readmissions were noted for this patient in the follow-up with worsened conditions. Discussion: This is a challenging case report since our hospital is an incapable cath-lab sub-district hospital and far from PCI-capable center. It is critical that all patients with AMI have a brief evaluation for mechanical complications such as VSR. All patients who developed hemodynamic instability during AMI should be comprehensively examined for the murmur and any other heart sound that may provide valuable information. Conclusion: Every clinician especially in the low-resource setting should be aware of this potentially fatal mechanical complication as the mortality remains significantly high. Early prompt diagnosis and treatment is the key of achieving an optimal outcome.

scholarly journals Ventricular septal rupture following acute myocardial infarction - a rare complication

2015 ◽  
Vol 9 (2) ◽  
pp. 121-123 ◽  
Author(s):  
Muhammad Mobarock Hossain ◽  
SM Mostafa Zaman ◽  
Fakhrul Islam Khaled ◽  
Mohammad Faisal Ibn Kabir ◽  
Noor Mohammad ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Rare Complication ◽  
Ventricular Septal Rupture

Abstract not availableUniversity Heart Journal Vol. 9, No. 2, July 2013; 121-123

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

2017 ◽  
Vol 33 (4) ◽  
pp. 291-294 ◽  
Author(s):  
Michael Rampoldi ◽  
Eric Kallstrom
Keyword(s):  
Myocardial Infarction ◽  
Surgical Intervention ◽  
Rapid Assessment ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
Anterior Myocardial Infarction ◽  
Postmyocardial Infarction ◽  
Life Threatening

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.

scholarly journals The Clinical Outcomes of Ventricular Septal Rupture Secondary to Acute Myocardial Infarction: A Retrospective, Observational Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Xin-Ying Zhang ◽  
Li-Zhao Bian ◽  
Nai-Liang Tian
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Revascularization ◽  
Serum Glucose ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
Logistic Regression Models ◽  
Wbc Count ◽  
Risk Predictors ◽  
Large Infarct

Background. Ventricular septal rupture (VSR) is a severe mechanical complication secondary to acute myocardial infarction (AMI) with a dreadful prognosis. The goal of our study was to evaluate the mortality and to identify the predictors of mortality for this population. Methods. From June 2012 to July 2021, patients with VSR secondary to AMI were initially screened for eligibility in this study. The potential risk predictors were determined using appropriate logistic regression models. Results. In this retrospective study, a total of 50 cases were included, and 14 patients survived and got discharged successfully. Univariable analyses indicated that the heart rate (HR), white blood cell (WBC) count, neutrophils count, serum glucose, serum creatinine, serum lactic acid, and the closure of rupture were significantly associated with mortality among these special populations. Conclusion. This study found that such high mortality in patients with VSR after AMI was significantly correlated with these risk factors representing sympathetic excitation and large infarct size. Coronary revascularization combined with the closure of rupture might be helpful in improving their prognosis.

scholarly journals Pulmonary artery banding for initial treatment of ventricular septal rupture

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
Yuta Koichi ◽  
Hiroto Kitahara ◽  
Naohiro Wakabayashi ◽  
Hayato Ise ◽  
Chiharu Tanaka ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Pulmonary Artery ◽  
Surgical Repair ◽  
Pulmonary Artery Banding ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
Transcatheter Intervention ◽  
Flow Through

Abstract Ventricular septal rupture (VSR) is a serious and fatal mechanical complication after acute myocardial infarction. Emergent or urgent, surgical/transcatheter intervention is necessary to treat VSR, though the outcome is not favorable. We performed temporary pulmonary artery banding (PAB) in an 85-year-old man who presented with chest pain to adjust the shunt flow through the VSR, which prevented further pulmonary edema and delayed the timing of surgical repair. There has been no report showing successful PAB performed for VSR after myocardial infarction.

scholarly journals P704 Mechanical complications of acute myocardial infarction in the era of early reperfusion therapy: a case report

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Proenca ◽  
R Alves Pinto ◽  
M Martins Carvalho ◽  
A Nunes ◽  
P M Araujo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular ◽  
Mechanical Complication ◽  
Heart Team ◽  
Inferior Wall ◽  
Early Reperfusion ◽  
Mechanical Complications ◽  
Biventricular Function ◽  
Risk Of Rupture

Abstract Introduction Left ventricular pseudoaneurysm is a rare mechanical complication of myocardial infarction, and its incidence has decreased with the widespread use of reperfusion therapies. Pseudoaneurysm is the result of a free wall rupture contained by pericardial adherences and mural thrombi, which contain the bleeding and prevent cardiac tamponade. Clinical Presentation A 68-year-old woman who had hypertension, diabetes mellitus and chronic kidney disease (caused by diabetic nephropathy) was first admitted with acute myocardial infarction of the inferior wall. Emergent coronary angiography revealed proximal occlusion of the right coronary artery. Primary angioplasty was performed with three stents implantation. However due to transitory no reflow, verapamil, nitrate and intracoronary abciximab were administered with recovery of coronary flow. Patient remained stable, without recurrence of symptoms. Echocardiography, at discharge, showed normal biventricular function and no mechanical complications. Two months later, the patient was readmitted in the emergency room with constant chest pain, fatigue, prostration and loss of appetite beginning ten days earlier and an episode of syncope. Physical examination revealed fever, cardiac auscultation was rhythmic and without murmurs or pericardial friction rub, and pulmonary auscultation revealed crackles in inferior hemithorax. 12-lead electrocardiogram showed sinus rhythm, Q waves and negative T waves in inferior leads. Blood tests revealed leucocytosis, high sensibility troponin I was 28,8 ng/L and brain natriuretic peptide was 264,9 pg/mL. Chest-X-ray demonstrated enlargement of the cardiac silhouette and echocardiography showed moderate to large pericardial effusion with large amounts of fibrin close to right cardiac chambers and a basal inferior pseudoaneurysm with 23 mm x 24 mm; intracavitary contrast was administered without opacification of pericardial space; biventricular function remained normal. Patient was promptly admitted on Cardiac Intensive Care Unit with diagnosis of pseudoaneurysm due to myocardial infarction. Therapeutic with ticagrelor was suspended and surgical correction was proposed, after discussion in Heart Team. False aneurysm correction was performed with a bovine pericardial patch without complications, and the patient was discharged asymptomatic eight days later. Conclusion Even with lower incidence, pseudoaneurysms remains as a potential life-threatening due to its high risk of rupture. Prompt diagnosis, usually with echocardiography and surgical referral are crucial. Abstract P704 Figure. Inferior Pseudoaneurysm

scholarly journals Ventricular Septal Rupture after Acute Coronary Syndrome

2019 ◽  
Vol 4 (10) ◽  
Author(s):  
Pedro Rafael de Oliveira Nascimento ◽  
Gustavo Henrique Belarmino Góes ◽  
Caroline Bernardi Fabro ◽  
Mateus Lopes Barreto de Sousa ◽  
Diana Patricia Lamprea Sepulveda ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Emergency Room ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
Early Therapy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Objective: Ventricular septal rupture (VSR) is a rare but serious complication of acute myocardial infarction, which occurs in about 0.2 to 0.3% of patients with myocardial ischemia. If early therapy is not initiated, 90% of patients with VSR will die within the first month. This study aimed to evaluate the epidemiological and clinical characteristics of patients with VSR as a mechanical complication of acute myocardial infarction. Methods: A prospective study was conducted among nine patients who presented to the Cardiovascular Emergency Room of Pernambuco with acute coronary syndrome with ST segment elevation and VSR complications. Results: There were five women and 4 men, and the mean age of the patients was 72.5 years. The median time from the onset of the symptoms of acute coronary syndrome with ST segment elevation to the diagnosis of VSR was 3.5 days. Among the nine patients included in the study, three were treated surgically. Of all the patients, including those who underwent corrective surgery, eight patients died, 44.4% (N = 4), in the first four days after AMI. Conclusion: VSR occurs more frequently among elderly patients with multi-arterial involvement, lower wall infarction, and involvement of the right coronary artery. The prognosis is extremely limited, especially in patients who are already admitted to the cardiac emergency room with Killip IV, with > 24 hours of clinical evolution, and do not require surgical correction.

scholarly journals A Case Report: Point-of-care Ultrasound in the Diagnosis of Post-Myocardial Infarction Ventricular Septal Rupture

2020 ◽  
Vol 4 (3) ◽  
pp. 407-410
Author(s):  
Andrew Portuguese ◽  
Khaled Abdulla ◽  
Michael Vornovitsky ◽  
John DeAngelis
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Point Of Care ◽  
Rare Complication ◽  
Artery Bypass ◽  
Heart Catheterization ◽  
Point Of Care Ultrasound ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
First Case

Introduction: Ventricular septal rupture (VSR) is a rare complication of ST-elevation myocardial infarction (STEMI), typically discovered post-revascularization. Case report: We present the first case of VSR detected on point-of-care ultrasound (POCUS) in the emergency department immediately prior to emergent angiography, with management positively affected by this discovery. The VSR was quickly confirmed via right heart catheterization. Subsequently, hemodynamic stability was achieved using an intra-aortic balloon pump. A delayed surgical VSR repair, with concomitant coronary artery bypass grafting, was implemented for definitive management. Conclusion: This case highlights the utility of POCUS in a STEMI patient with a suspected mechanical complication.

scholarly journals Epidemiology of Post-Infarction Ventricular Septal Rupture in Patients Undergoing Surgical Repair at Different Times from the Development of Acute Myocardial Infarction

2021 ◽  
pp. 18-25
Author(s):  
Ramil A. Aliyev ◽  
Yelizaveta O. Lebedieva ◽  
Mykhailo M. Grusha ◽  
Kamran K. Musayev
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Surgical Intervention ◽  
Rapid Development ◽  
Myocardial Reperfusion ◽  
Time Interval ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
Leading Role ◽  
Artery Disease

Introduction. The article is dedicated to the epidemiological aspects of the mechanical complication of acute myocardial infarction (AMI), particularly post-infarction ventricular septal rupture (VSR), problematic issues of its etiology and localization. Mortality of such patients is determined by rapid development of hemodynamic disorders and their severity, unpredictable clinical course, and the difficulty of early diagnosis. In addition, the high mortality rate of patients, especially when correcting the ventricular septal defect at the early stages after AMI, leaves open the question of the tactics of surgical treatment. The influence of certain risk factors of ischemic heart disease (IHD) on the development of post-infarction VSR is also considered. The aim. To study the epidemic features of post-infarction VSR in patients with different terms of surgical intervention after the development of AMI. Materials and methods. This study presents a retrospective analysis of 90 patients with coronary artery disease complicated by post-infarction VSR, who underwent surgical intervention for the period 2002-2019. The ages of hospitalized patients with post-infarction VSR ranged from 29 to 81 years. All the patients were divided into 3 groups depending on the time interval from AMI to surgical intervention. Results and discussion. It was found that post-infarction VSR is more common in men in the age range of 45-74 years after the manifestation of the first transmural AMI. More than a half of post-infarction VSR cases (56.7%) are associated with anterior localization of the ruptures in consequence of anterior AMI. Since the leading role in the treatment of AMI belongs to percutaneous coronary interventions (PCI), we analyzed the use of various reperfusion techniques to restore coronary blood flow in patients with post-infarction VSR. The analysis suggests that there are no statistically significant differences between the studied groups of patients with post-infarction VSR who underwent myocardial reperfusion (p = 0.103). Conclusions. The presence of chronic renal failure (CRF) in patients in the early post-infarction period can complicate the course of post-infarction VSR and affect perihospital mortality. The absence or untimeliness of myocardial reperfusion increases the risk of developing this complication of AMI. The ambiguous prognosis of treatment of post-infarction VSR makes a serious problem for clinicians.

scholarly journals Surgical treatment of mechanical complications following acute myocardial infarction. A Case Series.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Jorgjia Bucaj ◽  
Edvin Prifti
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Surgery ◽  
Papillary Muscle ◽  
Medical Centre ◽  
Main Body ◽  
Ventricular Septal Rupture ◽  
Papillary Muscle Rupture ◽  
Mechanical Complications ◽  
Muscle Rupture

Background: Acute myocardial infarction can result in ischemic, mechanical, arrhythmic, embolic or inflammatory complications. Despite high operative mortality, the lack of an effective and immediate medical alternative makes the surgery repair the mainstay of current management for these patients. Novel surgical approaches are presented to manage these complications. Main body: Mechanical complications presented at the Department of Cardiac Surgery-Tirana University Medical Centre consisted in nine cases during the period January 2008-June 2018: two anterolateral papillary muscle rupture cases (22%), one posteromedial papillary muscle rupture case (11%), two ventricular septal rupture cases (22%),  one free ventricle wall rupture case (11%),  three chordae tendineae rupture cases (33%), four out of nine patients (44,5%) underwent concomitant CABG intervention. Intra operator mortality is estimated 11% (one out of nine cases). The Department of Cardiac Surgery-Tirana University Medical Centre is limited only in open surgery techniques for repair the post myocardial infarction mechanical complications. To our personal view key reasons for these results are conditioned from lack of medical devices, trained stuff, reliable short and long outcome data from alternative procedures in order to incorporate thus in our daily practice. Further studies should be undertaken not only to create a precise image of the situation, but also to evaluate the results of the possible changes.  Key words: Acute myocardial infarction, mechanical complications, papillary muscle rupture, ventricular septal rupture, free ventricle wall rupture, CABG intervention.

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