Rupture Of Interventricular Septum Research Articles

Course and treatment of diabetes: from cardiovascular risk to catastrophe. Clinical case

As of today, type 2 diabetes mellitus and its complications impose a significant burden on healthcare systems worldwide. Myocardial infarction stands as a leading cause of death among patients with type 2 diabetes mellitus due to macroangiopathy resulting from glucose metabolism disorders and endothelial damage [5]. Unfortunately, even with timely assistance, patients with myocardial infarction may develop mechanical complications such as cardiac aneurysm, posing serious risks of myocardial wall rupture with a high likelihood of fatality. In most cases, interventricular septal rupture occurs, manifesting in 0,21% of cases of ST-segment elevation myocardial infarction (STEMI) and 0,04% of cases of non-STEMI. Surgical correction of the defect remains the only effective treatment method, albeit associated with a high risk of mortality. Consequently, intra- and post-operative complications in such patients prompt the search for alternative treatment modalities, including transcatheter closure of the defect [6]. Interventricular septal rupture more commonly occurs in older patients, women, those with hypertension, and chronic kidney disease. Typically, the defect arises against the backdrop of the first myocardial infarction in the absence of timely or absent reperfusion therapy. Interventricular septal rupture may develop within 1–14 days after STEMI. However, the incidence usually demonstrates a bimodal peak within the first 24 hours or 3–5 days after the infarction [12]. A clinical case of a patient with combined cardiometabolic pathology, namely, severe type 2 diabetes mellitus and post-infarction interventricular septal defect, is presented. The case underscores the issue of comorbidity in severe patients. Successful treatment of the patient was achieved through collaborative efforts of cardiac surgeons, intensivists, cardiologists and endocrinologists.

Up against the wall - emergency double myocardial rupture repair

BackgroundLeft ventricular free wall rupture (LVFWR) and interventricular septal rupture (VSR) are potentially catastrophic mechanical complications after acute myocardial infarction (AMI). When they occur together, “double myocardial rupture” (DMR), survival is unlikely. DMR is seen in only 0.3% of all AMIs. With or without surgical intervention, the odds are against the patient.Case presentationA 57-year-old male self-referred to the emergency department of a remote hospital 5 days after first experiencing chest pain. Investigations in ED confirmed an inferior ST-segment elevation myocardial infarction (STEMI) complicated by DMR. Coronary angiography revealed a mid-course total occlusion of the right coronary artery (RCA). He was rapidly transferred to our regional cardiac surgical unit, arriving straight into the operating theatre, in cardiogenic shock. He was briefly conscious, before arresting prior to intubation and being massaged onto bypass. Not only did he survive the all-night operation, requiring a mitral valve replacement in the process, but he survived multiple postoperative complications to be eventually transferred on postoperative day 66, neurologically intact, to a peripheral unit to complete his rehabilitation. He was subsequently discharged home 88 days after the operation and was able to ambulate with a walking frame into his first postoperative follow-up clinic appointment.ConclusionsOur patient, against all odds, has survived DMR and multiple postoperative complications. We present the details of his case and the literature surrounding the condition. The patient’s mental fortitude and his supportive family played a significant role, along with excellent multidisciplinary team work, in assuring his survival.

423 Up Against the Wall - Emergency Double Myocardial Rupture Repair

Abstract Background Left ventricular free wall rupture (LVFWR) and interventricular septal rupture (VSR) are potentially catastrophic mechanical complications after acute myocardial infarction (AMI). When they occur together ("double myocardial rupture" (DMR)), survival is unlikely. DMR is seen in only 0.3% of all AMIs. With or without surgical intervention, the odds are against the patient. Case presentation Our 57-year-old male patient self-referred to the emergency department of a remote hospital 5 days after first experiencing chest pain. Investigations in ED confirmed an inferior ST-segment elevation myocardial infarction (STEMI) complicated by DMR. Coronary angiography revealed a mid-course total occlusion of the right coronary artery (RCA). He was rapidly transferred to our regional cardiac surgical unit, arriving at the theatre in cardiogenic shock but conscious before arresting and being massaged onto bypass. Not only did he survive the all-night operation, requiring a mitral valve replacement in the process, but he survived multiple ITU complications to be eventually transferred, neurologically intact, on postoperative day 66 to a peripheral unit to complete his rehabilitation. He has been discharged from the rehabilitation centre 88 days after the operation, and He is now able to ambulate with a walking frame. Conclusions Our patient, against all odds, has survived DMR and multiple postoperative complications. We present the details of his case and the literature surrounding the condition. We hope patients with meagre probabilities, such as the patient seen in this case, are not given up on; hence, our final message from this report is to persevere and persist against all odds.

Diagnosis of interventricular septum rupture by means of computed axial tomography

Diagnosis of interventricular septum rupture by means of computed axial tomography

58 - Post-myocardial infarction ventricular septal defect due to interventricular septal rupture

58 - Post-myocardial infarction ventricular septal defect due to interventricular septal rupture

Impella Support for Surgical Ventricular Septal Defect Repair.

Acute postinfarct ventricular septal defect (VSD) is associated with high mortality due to a combination of cardiogenic shock and a complex repair in recently infarcted fragile myocardium. 1 Although the Impella heart pump is established as support for cardiogenic shock, it is relatively contraindicated in postinfarct VSD because of potential right-to-left shunt or stroke due to VSD tissue-related embolus. On autopsy, early repair is technically difficult due to tissue friability and as a result, 38% of surgically repaired patients have evidence of recurrent interventricular septal rupture. 2 Delayed surgical repair (>7 days) is associated with superior survival-54% after 7 days versus 18% prior-but hemodynamic instability may prevent delay. 3 Case reports have shown successful early left ventricular unloading with Impella patients with acute postinfarct VSD before surgical repair. 4,5 We discuss our algorithm for pre-repair Impella support in which we stratify pre-repair support based on the Qp/Qs ratio. For VSD with Qp/Qs >2.5, we use a preoperative Impella heart pump and have not demonstrated reversal in the left-to-right shunt on echocardiography and/or stroke. Our findings are consistent with theoretical models of unloading as demonstrated by shifts in pressure-volume loops. 6.

Endovascular correction of postinfarction ventricular septal defect: own successful experience

Despite the current development of cardiology, postinfarction rupture of the interventricular septum (IVS) is one of the most hazardous, life-threatening complications of acute myocardial infarction. The paper describes a clinical case of a 63-year-old female patient with a history of an acute ST-elevation myocardial infarction complicated by IVS rupture. The difficulties in the management of this patient and a comparative analysis of our treatment strategy with the available modern literature data on this issue are also presented.

Mechanical complications after myocardial infarction in a National Reference Hospital

To determine the clinical characteristics, therapeutic and in-hospital mortality of patients with mechanical complications post myocardial infarction. Observational, descriptive and retrospective study. We included patients >18 years old with a diagnosis of mechanical complication post myocardial infarction hospitalized at the Instituto Nacional Cardiovascular- INCOR in Lima -Peru, from January 1, 2017 to December 31, 2021. Variables like clinical characteristics, treatments, complications, and in-hospital mortality were studied. We found 37 cases, with a predominance of males (73.0%) and a median age of 73 years old. The location of the myocardial infarction was 51.4% in the anterior wall and 43.2% in the inferior wall. The patients received reperfusion therapy with fibrinolysis in 5 cases (13.5%), coronary angioplasty in 5 (13.5%), and 73% received only medical management prior to the diagnosis of mechanical complications. Of the 37 patients, 13 (35.1%) presented isolated ventricular free wall rupture, 12 (32.4%) isolated interventricular septum rupture, 10 (27.0%) the combination of ventricular free wall rupture and interventricular septum, and 2 (5.4%) papillary muscle rupture. In-hospital mortality was 51.4%. The ventricular free wall rupture was the most frequent complication, patients with mechanical complications after myocardial infarction still maintain high intra-hospital mortality rates, mainly in those who did not have adequate surgical treatment.

Различные модификации хирургического доступа и техники коррекции постинфарктного разрыва межжелудочковой перегородки

Различные модификации хирургического доступа и техники коррекции постинфарктного разрыва межжелудочковой перегородки

PECULIARITIES AND SURGICAL TREATMENT TACTICS OF POSTERO-BASAL LEFT VENTRICULAR ANEURYSMS

The literary review reflects the main current data on the problem of surgical treatment of postero-basal left ventricular aneurysms. It is shown that, despite the small percentage of these aneurysms in patients with coronary heart disease (CHD), their importance for surgical treatment is significant, since the effective correction of detected disorders of cardiac structures, myocardium and coronary arteries has not been sufficiently developed to date, and many issues of surgical tactics are contradictory. This applies both to the type of geometric reconstruction of the left ventricle, and the feasibility of mitral regurgitation correction, which due to dysfunction of the papillary muscles is observed in almost all patients with postero-basal aneurysms of the heart. The question of the combined correction of the interventricular septum rupture in patients with postero-basal aneurysms remains complex and unresolved until now. The relevant problem is the choice of surgical tactics of left ventricular reconstruction using two patches in the presence of anteroposterior aneurysms. All of the above reflects the need for further research on the problem of surgical treatment of postero-basal aneurysms of the heart.

Bedside Echocardiography in Acute Myocardial Infarction Patients with Hemodynamic Deterioration

Ventricular septal (VS) rupture after acute myocardial infarction (AMI) is an uncommon complication in the reperfusion era. Bedside echocardiography (BECH) continues to be a strong diagnostic tool for emergency physicians treating dyspneic patients, especially for decision-making on the management strategies to use with these unstable patients. In the case we present here, a patient is diagnosed with a delayed mechanical complication after AMI, and a swift management plan is made with the aid of point-of-care BECH. The patient is a 72-year-old man with dyspnea who was admitted to the ED 5 days after receiving a primary percutaneous coronary intervention with stent implantation for AMI; in the ED, the patient was diagnosed, via BECH, with a VS rupture. On arrival, his vital signs and the results of his physical examination depicted shock and low perfusion with wet lung. A cardiac examination revealed a new 2/6 harsh holosystolic murmur along the left sternal border without pretibial oedema. Emergency physicians performed BECH, and subcostal views of the heart revealed a wide interventricular septal rupture and left-to-right shunting with minimal pericardial effusion. The patient underwent surgery immediately to repair the defect. The post-operative course was uneventful, and he was discharged in stable condition on the seventh day after the surgery. The use of BECH to recognize a VS rupture is critical because such a defect may be the most important determinant of mortality in AMI patients who are in shock. BECH thus can influence clinicians' acute management and disposition decisions.

Surgical management of interventricular septal rupture

Surgical management of interventricular septal rupture

Ejection fraction - A number to be interpreted with caution!

Cardiogenic shock is frequently seen following acute myocardial infarction complicated by the rupture of interventricular septum and formation of functional ventricular septal defect. Despite significant advances in medical, interventional and surgical management, the mortality in this group of patients remains very high. We present a case of refractory cardiogenic shock following an exclusion bovine pericardial patch repair of post infarction ventricular septal defect, where the residual functional left ventricular cavity size was insufficient to maintain end organ function. This case illustrates the concept of "Normal ejection fraction low cardiac output cardiogenic shock", where reporting left ventricular ejection fraction number in isolation can be misleading.

Early interventricular septum rupture after systemic thrombolysis in a patient with STEMI

Intraventricular septal rupture (ISR) is one of the most dreadful complications during AMI, requiring early diagnosis and urgent surgery. However, medical (90%) and surgical (50%) mortality remain elevated. We report a case of a 59 years old patient with infero-posterior AMI complicated by ISR after thrombolysis. Despite early recognition of this complication by trans-thoracic echocardiography at bedside and prompt surgical intervention the patient died on the second post-surgical day.

Endovascular treatment of a traumatic ventricular septal rupture and coronary to ventricular fistula.

About 10% of patients with chest trauma present with cardiac injuries, associated with 60% to 97% mortality [1, 2]. Penetrating cardiac traumas may injure not only the myocardium, but also other cardiac structures. Therefore timely and rapid diagnosis is critical for improving patient outcome. A 27-year-old man was admitted to our department with exertional angina and dyspnea limiting his activities in the last week. A grade 2/6 continuous murmur was heard at the left sternal border of his chest. He had a history of sudden cardiac arrest due to stabbing to the thoracic region 1 month ago. According to the patient’s report, he had been taken to the surgery emergently without further evaluation after successful cardiopulmonary resuscitation because of massive pericardial effusion and right ventricular collapse in transthoracic echocardiography (TTE). As operative treatment, a large hemothorax and a tense hemopericardium had been drained, and the right ventricular laceration had been repaired. After a postoperative recovery period with normal control TTE, the patient was discharged. In our clinic, diagnostic transesophageal echocardiography (TEE) revealed turbulent flow with 0.53 mm diameter across the interventricular septum with normal left ventricular dimensions (Figure 1). Diagnostic angiography was performed to detect additional cardiac injuries. On his angiogram, the right coronary artery and the circumflex artery were normal. However, contrast material passed from the left anterior descending artery (LAD) to the right ventricle via a large fistula, the proximal segment of the LAD was large and tortuous, and the distal segment of the LAD after the fistula was very small due to poor distal flow (Figure 2 A). Ventriculography revealed normal left ventricular contraction with contrast flow from the left to the right ventricle at the mid portion of the interventricular septum (Figure 2 B). After discussion with cardiac surgeons we decided that the best therapeutic approach was surgery, but the patient refused the recommended redo surgery. So we decided to continue treatment with percutaneous closure. Before the procedure the patient received 80 mg of gentamicin and 2 g of cefazolin for endocarditis prophylaxis as well as 80 U/kg of unfractionated heparin by the intravenous route. The Seldinger technique was used to insert an 8 Fr introducer into both the femoral artery and jugular vein under general anesthesia. A 7 Fr pigtail catheter was advanced into the left ventricle. The ventricular septal rupture was measured before the procedure with TEE in the long axis view for occluder device size selection. An 0.038 inch J type PTFE coated hydrophilic guidewire was inserted via the right jugular vein across the tricuspid valve, through the septal rupture and aortic valve and located in the ascending aorta. This wire was exteriorized from the right femoral artery using a snare wire. A 4.0 mm membranous VSD occluder device (St. Jude Medical) was inserted by the Torqvue delivery system (45° angle curve) via the right jugular vein and advanced through the interventricular septal rupture and deployed under TEE guidance. Control left ventriculography showed a successful deployment with no residual shunting (Figure 2 C). After a 0.014 inch floppy guidewire was introduced into the LAD system, a 4.0 mm × 1.8 mm coronary graft stent was implanted at the aneurysm neck level, followed by post-dilatations using a 4.5 mm × 1.5 mm invader balloon. The aneurysm was completely sealed with restoration of normal flow into the distal LAD (Figure 2 D). The patient was discharged on the following day without any complications. Clopidogrel 75 mg/day for 2 months along with life-long ASA 100 mg/day were recommended. Figure 1 Flow from right to left ventricle in TEE examination with color Doppler suggesting a ventricular septal rupture Figure 2 Contrast passing from LAD artery into the right ventricle via a fistula (A, arrow). Contrast flow from left to right ventricle at distal portion of interventricular septum (B, arrow). Control angiography of interventricular septum with no residual shunting ... Because timely and rapid diagnosis is critical for improving patient outcome, physicians who see the patient in the emergency room should suspect and rule them out or confirm them as soon as possible. Echocardiography is a diagnostic tool for the rapid bedside evaluation of cardiac trauma and quickly provides a high level of diagnostic accuracy, and therefore is especially useful preoperatively when cardiac trauma is strongly suspected and the patient is hemodynamically stable [3]. However, it was previously reported that the incidence of delayed sequelae of penetrating cardiac injury was 23% using only TTE [4]. Hence a comprehensive transesophageal echocardiographic examination is imperative, because penetrating cardiac trauma may injure not only the myocardium, but also other cardiac structures such as coronary arteries, cardiac valves, interatrial or interventricular septa, multiple cardiac chambers, or the great vessels.

Interventricular Septum Rupture in the Catheterization Laboratory

Interventricular Septum Rupture in the Catheterization Laboratory

Complex Ventricular Septal Rupture with Dissection of the Right Ventricular Wall in Ischemic Context

A 72-year-old man was admitted to the local hospital with non-ST elevation myocardial infarction. In the first 24 hours, a new onset apical murmur was heard. Transthoracic and transesophageal echocardiography showed interventricular septal (IVS) rupture and dissection of the right ventricle (RV) wall forming an echolucent pseudocavity that partially occupied the RV and communicated with the true RV cavity. Multislice computed tomography characterized in detail the IVS and RV wall dissection, and further showed the right coronary artery in the outer border of the RV and pseudocavity, excluding pericardial fluid. Despite surgical correction, progression to cardiogenic shock and death occurred 33 days after admission.

Combination of several rare complications of myocardial infarction in a single patient

There are three major mechanical complications of acute myocardial infarction: rupture of the left ventricular free wall, rupture of the interventricular septum, and development of mitral regurgitation. Each of these complications is associated with extremely high mortality. Reviewing the scientific literature, we found descriptions of sporadic cases of both of those complications combined. We report an unusual case of simultaneous rupture of free wall and interventricular septum.

Ventricular septal defect, developed due to the coronary artery injury after blunt chest trauma in childhood

In the literature, cardiac response associated with blunt chest trauma in children has been reported generally as case reports, and interventricular septal rupture due to trauma is quite rare. Interventricular septal rupture can develop even in the absence of visible signs of a trauma because of the flexibility of the chest structure in children. In the present case, a seven-year-old boy with interventricular septal rupture at the mid-muscular region and left ventricle pseudoaneurysm developed due to injury to the left anterior descending coronary artery after a traffic accident is reported. Patients with cardiac murmur detected on physical examination after a blunt chest trauma must be considered as cardiac injury, and in those with signs of ischemia detected on electrocardiography, it should not be forgotten that the coronary artery may be affected.

Interventricular septal rupture caused by vehicular trauma

We report the case of a patient admitted at the emergency unit after a severe car accident. As ECG showed a ST segment elevation in all leads, the working diagnosis was coronary dissection. Coronary angiography revealed a large interventricular septal rupture, confirmed by echocardiography. After discussion and as haemodynamics permitted, 6 weeks of medical observation were decided. A surgical repair was then performed, and provided a perfect repair of the shunt. We discuss about the prevalence and management of this rare traumatic complication.