scholarly journals Challenges in treatment of postinfarction ventricular septal defect and heart failure

2015 ◽  
Vol 72 (1) ◽  
pp. 68-71 ◽  
Author(s):  
Ljupco Mangovski ◽  
Rainer Kozlik-Feldmann ◽  
Miodrag Peric ◽  
Ljiljana Jovovic ◽  
Mihajlo Farkic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Angiography ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Left Ventricular ◽  
Mechanical Complication ◽  
Surgical Closure ◽  
Direct Stenting ◽  
Septal Occluder Device

Introduction. Acquired ventricular septal defect (VSD) is uncommon, but serious mechanical complication of acute myocardial infarction with poor outcome and high mortality rate in surgically or medically treated patients. Case report. We report a 58-year-old male patient admitted to our hospital six days following acute inferior myocardial infarction complicated by ventricular septal rupture with signs of heart failure. Coronary angiography revealed 3-vessel disease, with proximally occluded dominant right coronary artery. Transthoracic echo exam revealed aneurysm of a very thin inferior septum and the basal portion of the inferior left ventricular wall, with septal wall rupture. One of the VSD dimensions was 15 mm and left- to right shunt was calculated 2 : 1. Since the patient was at too high risk for surgical closure, transcatheter closure of VSD was chosen as a better option. Under short intravenous sedation, 24 mm Amplatzer device was implanted percutaneously with transesophageal echo guidance. The post-procedural result revealed a small residual shunt, but it was followed by significant improvement of the patient?s clinical status. A 24h Holter ECG monitoring did not show cardiac rhythm or conduction disturbances. Coronary angiography was repeated ten days following the procedure, after hemodynamic stabilization of the patient, with direct stenting of the circumflex artery and the intermediate artery. Ostial left descending artery lesion was left for further functional significance assessment. Conclusion: Percutaneous closure with a septal occluder device can be definitive primary treatment for anatomically suitable patients or it can serve as a bridge to surgical treatment.

scholarly journals Surgical Treatment of Ventricular Septal Defect Following Myocardial Infarction: A Case Report

Medicina ◽  
2013 ◽  
Vol 49 (4) ◽  
pp. 32
Author(s):  
Eglė Ereminienė ◽  
Rūta Jurgaitienė ◽  
Rimantas Benetis ◽  
Giedrė Bakšytė ◽  
Giedrė Stanaitienė
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Elective Surgery ◽  
Mechanical Complication ◽  
Aggressive Approach ◽  
Surgical Closure ◽  
Intra Aortic Balloon Pump ◽  
Life Threatening ◽  
Prompt Diagnosis

Ventricular septal defect after myocardial infarction is a rare but often life-threatening mechanical complication. The keys of management are a prompt diagnosis of ventricular septal defect and an aggressive approach to stabilize patient’s hemodynamics. Invasive monitoring, judicious use of inotropes and vasodilators, and an intra-aortic balloon pump are recommended for the optimal support of patient’s hemodynamics. The best results are achieved if optimally medically managed patients survive at least 4 weeks before elective surgery necessary for scar formation in a friable infarcted tissue. We report a case of acute myocardial infarction complicated by the rupture of ventricular septum. Instead of attempting an immediate surgical closure of ventricular septal defect, the postponed surgery was successfully performed 3 weeks after the occurrence of ventricular septal defect. Preoperatively, clinical and hemodynamic conditions of the patient were maintained stable with the support of an intra-aortic balloon pump and inotropes.

scholarly journals LEFT VENTRICULAR ANEURYSM AND VENTRICULAR SEPTAL DEFECT FOLLOWING MYOCARDIAL INFARCTION: A DANGEROUS COCKTAIL

2021 ◽  
Vol 07 (06) ◽  
Author(s):  
HALA EL ASSILI ◽  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Septal Defect ◽  
Poor Prognosis ◽  
Septal Defect ◽  
Interventricular Septum ◽  
Surgical Techniques ◽  
Left Ventricular ◽  
Left Ventricular Aneurysm ◽  
Mechanical Complication ◽  
Ventricular Aneurysm

An ischemic ventricular septal defect (VSD) is a lethal complication of myocardial infarction (MI), commonly from 24 hours to up to 5 days of presentation with AMI. Despite the improvement of surgical techniques, the mortality is still very high with poor prognosis. Left ventricular aneurysm (LVA) may also be a fatal mechanical complication of MI but rarely occurs in the posterior or inferior portion of the interventricular septum. Concomitant AMI mechanical complications in the same patient are less than infrequent with poor prognosis, particularly with late hospital arrival. We present an unusual case of post-myocardial infarction ventricular septal rupture (PI-VSR) combined with left ventricular inferior/inferoseptal aneurysm that was managed surgically. The aim of this article is to make clinician alerted in case of mechanical complication, especially when post-MI patients become hemodynamically unstable with refractory congestive heart failure.

Echocardiographic Evaluation of Cardiac Remodeling After Surgical Closure of Ventricular Septal Defect in Different Age Group

2017 ◽  
Vol 2 (2) ◽  
pp. 69-74
Author(s):  
Mohammad Aminullah ◽  
Fahmida Akter Rima ◽  
Asraful Hoque ◽  
Mokhlesur Rahman Sazal ◽  
Prodip Biswas ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Ejection Fraction ◽  
Cardiac Remodeling ◽  
Septal Defect ◽  
Left Ventricular ◽  
Age Group ◽  
Surgical Closure ◽  
Group A ◽  
Group B ◽  
Fractional Shortening

Background: Cardiac remodeling is important issue after surgical closure of ventricular septal defect.Objective: The purpose of the present study was to evaluate cardiac remodeling by echocardiography by measuring the ejection fraction, fractional shortening, left ventricular internal diameter during diastole (LVIDd) and left ventricular internal diameter during systole (LVIDs) after surgical closure of ventricular septal defect in different age group. Methodology: This prospective cohort studies was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka. Patient with surgical closure of VSD were enrolled into this study purposively and were divided into 3 groups according to the age. In group A (n=10), patients were within the age group of 2.0 to 6.0 years; age of group B (n=8) patients were 6.1-18.0 years and the group C (n=6) aged range was 18.1-42.0 years. Echocardiographic variables such as ejection fraction, fractional shortening, LVIDd, LVIDs were taken preoperatively and at 1st and 3rd month of postoperative values. Result: A total number of 24 patients was recruited for this study. The mean ages of all groups were 12.60±12.09. After 1 month ejection fraction were decreased by 5.97%, 6.71% and 5.66% in group A, group B and group C respectively. After 3 months ejection fraction were increased by 6.13%, 5.13% and 5.14% in group A, group B and group C respectively. After 1 month fractional shortening were decreased by 13.55%, 9.30% and 9.09% in group A, group B and group C respectively. After 3 months fractional shortening were increased by 7.23%, 7.35% and 4.55% in group A, group B and group C respectively. After 1 month LVIDd were increased by 1.97%, 1.91% and 1.32% in group A, group B and group C respectively. After 3 months LVIDd were decreased by 10.84%, 9.89% and 7.34% in group A, group B and group C respectively. After 1 month LVIDs were increased by 2.19%, 2.86% and 1.98% in group A, group B and group C respectively. After 3 months LVIDs were decreased by 11.68%, 10.97% and 8.87% in group A, group B and group C respectively.Conclusion: Cardiac remodeling occurred after surgical closure of ventricular septal defect and remodeling were more significant in younger age group. Journal of National Institute of Neurosciences Bangladesh, 2016;2(2):69-74

scholarly journals A case report of unexpected right-to-left shunt under mechanical support for post-infarction ventricular septal defect: evaluation with haemodynamic simulator

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Arudo Hiraoka ◽  
Keita Saku ◽  
Takuya Nishikawa ◽  
Kenji Sunagawa
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Septal Defect ◽  
Cardiac Function ◽  
Septal Defect ◽  
Left Ventricular ◽  
Haemodynamic Instability ◽  
Shunt Flow ◽  
Oxygenation Level ◽  
The Right

Abstract Background Post-myocardial infarction ventricular septal defect (PIVSD) is a complication of acute myocardial infarction with high mortality. A percutaneous left ventricular assist device, Impella, is currently used in maintaining haemodynamic stability in PIVSD. Case summary A 65-year-old man was transferred to our hospital for treatment of acute myocardial infarction of the proximal right coronary artery. Percutaneous intervention was performed but haemodynamic instability continued. At 10 days after onset, the patient was diagnosed with PIVSD by echocardiogram. To stabilize haemodynamics, we initiated venoarterial extracorporeal membrane oxygenation (ECMO). Three days after ECMO initiation, pulmonary congestion increased and an echocardiogram revealed closed aortic valve and spontaneous echo contrast at the aortic root. After an Impella 2.5 was inserted for unloading of the left ventricle, the oxygenation level and cardiac function rapidly declined. Unexpectedly, an echocardiogram showed a right-to-left shunt (to-and-fro pattern) via PIVSD. By increasing the ECMO and decreasing Impella flow, the shunt flow changed to left-to-right, and oxygenation level and cardiac function improved. Ten days after ECMO was started, elective surgical repair was successfully performed. Conclusion ECPELLA (ECMO + Impella) can offset the adverse effects of isolated ECMO support and reduce the PIVSD shunt flow. However, the risk of right-to-left shunt has not been reported, and ECPELLA caused a right-to-left shunt with deoxygenated systemic perfusion in the present case. A simulation study indicated that the right ventricular failure in PIVSD may pose a risk for right-to-left PIVSD shunt under Impella support.

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