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

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.

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

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479316687992 ◽

2017 ◽

Vol 33 (4) ◽

pp. 291-294 ◽

Cited By ~ 2

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.

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

ACI (Acta Cardiologia Indonesiana) ◽

10.22146/jaci.v7i1.385 ◽

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.

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

Journal of Interventional Cardiology ◽

10.1155/2021/3900269 ◽

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.

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Pulmonary artery banding for initial treatment of ventricular septal rupture

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa010 ◽

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.

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Ventricular Septal Rupture after Acute Coronary Syndrome

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol04-i10/741 ◽

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.

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TIMING OF SURGICAL INTERVENTION AFTER VENTRICULAR SEPTAL RUPTURE

Gulustan-Black Sea Scientific Journal of Academic Research ◽

10.36962/gbssjar17 ◽

2019 ◽

Vol 48 (05) ◽

pp. 17-21

Author(s):

Guliko Kiliptari

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Surgical Management ◽

Surgical Intervention ◽

Haemodynamic Instability ◽

Ventricular Septal Rupture ◽

Middle Segment ◽

Adequate Treatment ◽

St Segment ◽

Heart Rupture

Ventricular septal rupture (VSR) is a rare but lethal complication of acute myocardial infarction (AMI). patients presenting with ST-elevation MI (STEMI) were evaluated for heart rupture (VSR ) based on reperfusion strategy. , After undergoing a primary percutaneous coronary intervention (PCI), VSR was reported to occur in 0.23-0.71% of patients. Post-infarction VSR carries significant mortality (36.%) despite aggressive surgical management. Rupture develops after full-thickness (transmural) infarction of the ventricular septum and can occur at any anatomic location. Ventricular septal rupture is likely to be associated with total occlusion of the infarct-related artery. the newly formed communication results in left to right shunting of oxygenated blood from the high-pressure left ventricle to the lower-pressure right ventricle. .Mortality was highest in patients who underwent operation in the first 24 h, consistent with other investigators. The case reflects the important problem after myocardial infarction , ventricular septal rupture and challenges the timing of intervention Patient 70 year old,male,caucasion was admitted in our hospital with encephalopathy and hypotension.ECG revealed ST segment elevation in II,III,AVF,V4-V6 lead,ST segment depression in AVL,V1-V3 lead. Koronarography detected left main artery without important stenosis, 95 % stenosis of middle segment and 75% stenosis of distal part of left anterior descending artery.40% stenosis of middle segment of right coronary artery, occlusion of posterior descending artery.After recanalization and balloon predilatation of posterior descending artery, was parformed drug eluted stant implantation. transthoracic echocardiography (TTE) detected of postinfarction VSR (pict 3). The Colour Doppler was demonstrated of flow across the septum and left to rigt shunt. Conclusion: Ventricular septal rupture (VSR) is a rare but lethal complication of acute myocardial infarction (AMI). Mortality of patients is significantly depending o n timing of surgery. Operative management of patients can be complex, and having a systematic approach is helpful. The cornerstone of medical management of VSR is afterload reduction, and may be considered routine care.. According our case , surgical intervention was delayed and dispite adequate treatment patient was died . There is no clear evidence to guide the surgical management of patients who are in shock, as all approaches have shown extremely high mortality. Possible strategies include emergent surgery on individuals with marked haemodynamic instability and circulatory compromise.

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Transcatheter closure of post myocardial Infarction ventricular septal rupture with the Amplatzer Septal occluder

Nepalese Heart Journal ◽

10.3126/njh.v18i2.40408 ◽

2021 ◽

Vol 18 (2) ◽

pp. 65-68

Author(s):

Chandra Mani Adhikari ◽

Manish Shrestha ◽

Birat Timalsina ◽

Amrit Bogati ◽

Madhu Rokka ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Surgical Intervention ◽

Transcatheter Closure ◽

Amplatzer Septal Occluder ◽

Ventricular Septal Rupture ◽

Surgical Closure ◽

Amplatzer Device ◽

Life Threatening ◽

Life Threatening Complication

Ventricular septal rupture is a rare yet life threatening complication of acute myocardial infarction. Surgical closure is the treatment of choice however despite surgical intervention mortality remains high. Transcatheter closure of ventricular septal rupture has emerged as a new alternative strategy which is less invasive potentially allowing early hemodynamic stabilization. We report a case of a 60-year-old male with post infarction ventricular septal rupture who was treated with percutaneous closure using an Amplatzer device at Shahid Gangalal National Heart Centre, Nepal.

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Transcatheter Closure of Ventricular Septal Rupture First in Bangladesh - A Case Report

Cardiovascular Journal ◽

10.3329/cardio.v7i2.22264 ◽

2015 ◽

Vol 7 (2) ◽

pp. 150-152

Author(s):

NAM Momenuzzaman ◽

Solaiman Hossain ◽

Fatema Begum ◽

Kaisar Nasrullah Khan ◽

AM Shafique ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Surgical Intervention ◽

Transcatheter Closure ◽

Rare Complication ◽

Rapid Diagnosis ◽

Ventricular Septal Rupture ◽

Short Term ◽

Amplatzer Device ◽

Short Term Mortality

Ventricular septal rupture is a rare complication of acute myocardial infarction with important hemodynamic consequences. Without a rapid diagnosis and correction by surgical intervention, the short-term mortality of these patients is higher than 90%. Early diagnosis is based on clinical examination and transthoracic echocardiography. Transcatheter closure of ventricular septal rupture in selected patients may save lives. We report a patient with ventricular septal rupture in acute myocardial infarction that was closed by an Amplatzer device. DOI: http://dx.doi.org/10.3329/cardio.v7i2.22264 Cardiovasc. j. 2015; 7(2): 150-152

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Clinical Outcome of Ventricular Septal Rupture Complicating Acute Myocardial Infarction – A Single Centre Retrospective Study

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i43b32544 ◽

2021 ◽

pp. 197-203

Author(s):

Jayanty Venkata Balasubramaniyan ◽

Ravanasamudram Hariharan Lakshmi ◽

Harsimran Singh ◽

J. S. Sathyanarayana Murthy ◽

Vaishnavi Chandrakumar

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Retrospective Study ◽

Tertiary Care ◽

Early Mortality ◽

High Rate ◽

Mechanical Complication ◽

Ventricular Septal Rupture ◽

Tertiary Care Centre ◽

History Of

Objective: Ventricular Septal Rupture (VSR) following Acute Myocardial Infarction (AMI) is a fatal mechanical complication with high incidence of mortality. The aim of this study is to explore the clinical outcomes and to identify the factors related to early mortality in patients with VSR after AMI. Materials and Methods: This was a retrospective study and we collected clinical data of 21 adult patients with VSR following AMI from April 2012 and October 2020 who got admitted at our tertiary care centre. The patients were classified into two groups. The first group consisted of patients who died within two weeks from the diagnosis of VSR following AMI and the second group comprised of patients who survived more than two weeks after VSR. Results: A total of 21 patients (mean age of 66.19±9.47 years) were enrolled in this study. The most common MI was Anterior MI (71.4%) and the location of VSR was predominantly in the anterior and apical septum (76.2%). The overall early mortality was 85.9% (n=18). 80.95% (n=17) of patients died within two weeks of diagnosis of AMI. Of the 4 patients who survived more than two weeks, three patients survived. The operative mortality in our study was 47%. Conclusion: The prognosis for VSR in AMI remains poor. Renal failure is accompanied with high rate of early mortality in patients with VSR complicating AMI. History of smoking is associated with poor outcome.

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Percutaneous Coronary Intervention in Post-Infarction Ventricular Septal Rupture

Health Notions ◽

10.33846/hn50407 ◽

2021 ◽

Vol 5 (4) ◽

pp. 146-150

Author(s):

Suryono Suryono ◽

Naesilla Naesilla ◽

Ika Aulia Kurniasari ◽

Toyibatul Hidayati ◽

Madha Qoyyulledy Tursina ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Definitive Treatment ◽

Drug Eluting Stent ◽

Mechanical Complication ◽

Ventricular Septal Rupture ◽

Percutaneous Coronary

Background: Ventricular septal rupture (VSR) is a fatal mechanical complication following acute myocardial infarction (AMI). The definitive treatment remains surgical repair, however several aspects are still debatable, including the timing of surgery. Patient’s refusal of treatment and lack of medical facilities put other challenges in management of VSR. Case presentation: A-48-year-old male with a history of diabetes mellitus and hypertension came with a late-presentation anterior AMI, and refused the reperfusion therapy. By the third day, he developed VSR and cardiogenic shock. The patient was also against any referral plan for further therapy. Hemodynamic status was optimally controlled with vasopressor and inotropic agents. The patient was discharged with a grade II-III New York Heart Association (NYHA) on the tenth day. In follow up evaluation a week later, the patient presented limb swelling and functional NYHA class III-IV. The patient agreed to received percutaneous coronary intervention (PCI). Drug eluting stent (DES) in left anterior descending (LAD) coronary artery was implanted successfully without defect closure. Follow-up after 12-months revealed no signs or symptoms of decompensated heart failure. Keywords: ventricular septal rupture; percutaneous coronary intervention; acute myocardial infarction

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