Diagnosis and Management of Post-myocardial Infarction Ventricular Septal Defects

Abstract

As the treatment of acute myocardial infarction has evolved from conservative management to thrombolysis and, in more recent times, primary angioplasty, the incidence of ventricular rupture, in particular post-infarction ventricular septal defect (VSD), appears to have fallen. In this article we discuss the clinical presentation and investigation of post-infarction VSD, the natural history as well as surgical and percutaneous interventional management and outcomes. Very limited published information is available from small series reports with the inherent limitation of selection bias. Survival is clearly enhanced by surgical or percutaneous intervention. Overall outcomes remain suboptimal but do appear to be significantly better in the absence of cardiogenic shock and if the procedure can be deferred, factors which are clearly related. Further research is required in this difficult field.