scholarly journals TIMING OF SURGICAL INTERVENTION AFTER VENTRICULAR SEPTAL RUPTURE

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.

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

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. 

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

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

scholarly journals Clinical Characteristics and Contemporary Prognosis of Ventricular Septal Rupture Complicating Acute Myocardial Infarction: A Single-Center Experience

2021 ◽  
Vol 8 ◽  
Author(s):  
Lu Wang ◽  
Li-Li Xiao ◽  
Chao Liu ◽  
Yan-Zhou Zhang ◽  
Xiao-Yan Zhao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Surgical Management ◽  
Clinical Characteristics ◽  
Operative Management ◽  
Outcome Data ◽  
Ventricular Septal Rupture ◽  
Single Center ◽  
Long Term Mortality

Objectives: Ventricular septal rupture (VSR) is a rare but lethal complication of acute myocardial infarction (AMI). We conducted a retrospective analysis of the clinical characteristics of VSR patients and explored the risk factors for long-term mortality.Methods: In this single-center cohort study, 127 patients diagnosed with post-AMI VSR between May 2012 and April 2019 were included. Demographic, clinical, operative, and outcome data were collected. The 30-day and long-term mortality were outcomes of interest. Cox proportional hazard regression analysis was used to explore the predictors of long-term mortality.Results: The mean age of the VSR cohort was 66.6 ± 8.7 years, 67 (52.8%) were males. Among the 127 patients, 78 patients (61.4%) were medically managed, 31 (24.4%) patients underwent percutaneous transcatheter closure (TCC), and 18 (14.2%) patients received surgical repair. The median follow-up time was 1129 days [interquartile range: 802–2019 days]. The 30-day mortality of the medically managed group, percutaneous TCC group, and surgical management group was 93.6, 22.6, and 11.1%, respectively; and the long-term mortality was 96.2, 25.8, and 22.2%, respectively. VSR repair treatment including surgical management (HR 0.01, 95% CI 0.001–0.09, p < 0.001) and percutaneous TCC (HR 0.09, 95% CI 0.03–0.26, p < 0.001) was associated with a better prognosis, and cardiogenic shock (CS) (HR 9.30, 95% CI 3.38–25.62, p < 0.001) was an independent risk factor of long-term mortality.Conclusions: The prognosis of VSR patients without operative management remains poor, especially in those complicated with CS. Timely and improved surgery treatment is needed for better outcomes in VSR patients.

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