Rupture Of Interventricular Septum Research Articles

CORRELATION BETWEEN FILLING PATTERN AND COMPLICATIONS DURING THE FIRST WEEK AFTER ACUTE MYOCARDIAL INFARCTION IN HYPERTENSIVE PATIENTS: PP.26.46

Background: An increased filling presure is revealed by a severe diastolic dysfunction, associated with a large acute myocardial infarction (AMI) and the risk of acute complications. Aim of the study was to find a correlation between the pattern of distolic mitral inflow and the complications during the first week after AMI in hypertensive patients. Methods: A number of 98 hypertensive patients (56 males and 43 females) aged 36 - 82 years, admitted with acute myocardial infarction with ST-segment elevation were evaluated in the first week of hospitalization by: clinical examination: angina, heart failure symptoms, 12 lead standard ECG, Holter: the presence of arrythmias, echocardiographic measurement of diastolic mitral inflow using Doppler method, the presence of complications: left ventricular aneurysm, left ventricular thrombus, rupture of interventricular septum, using transthoracic echocardiography. Patients were divided in 4 groups: 1. LVH+ and reperfusion 2. LVH+ without reperfusion 3. LVH- and reperfusion 4. LVH- without reperfusion. Results: 1. LVH was found in 67 patients (68,36%). 2. Failled reperfusion was present in 16,33% patients with LVH and 36,73% in patients with LVH which matched not criterias for thrombolitic therapy administration. 3. In hypertensive patients with LVH and without successful reperfusion pseudonormal pattern was found in 10,20% and restrictive pattern in 10,20% percentage. 4. Complications during the first week were more frequent in patients with pseudonormal pattern: angina: 55%, pericarditis: 20%, heart failure classes NYHA III and IV: 80%, aneurysm: 25%, thrombus: 5%, atrial fibrillation: 25% and restrictive pattern: angina: 57,14%, pericarditis: 50%, heart failure classes NYHA III and IV: 100%, aneurysm: 42,85%, thrombus: 35,71%, rupture of interventricular septum: 7,14%, atrial fibrillation: 71,42%. Conclusions 1. The most severe patterns of diastolic dysfunction such as pseudonormal and restrictive were present in hypertensive patients with LVH and without successful reperfusion. 2. In these patients complications during the first week of hospitalization were more frequent. 3. We can conclude that an increased filling pressure revealed by a severe diastolic disfunction were associated with short therm complications after AMI.

Rotura extensa de septo interventricular por traumatismo torácico cerrado

Interventricular septum rupture following blunt chest trauma is a rare cardiac injury that sometimes is difficult to diagnose. It has a high mortality rate, especially when in cases of hemodynamic instability requiring early surgical repair. We report the case of an 18-year old man who suffered blunt thoracoabdominal trauma and hemorrhagic shock who required emergency abdominal surgery on three occasions. He was diagnosed of traumatic rupture of interventricular septum that had not been detected in the initial echocardiography, but was suspected after the right heart catheterism. Urgent cardiac surgery was performed 72 hours later because of hemodynamic instability.

Double rupture of interventricular septum and free wall of the left ventricle, as a mechanical complication of acute myocardial infarction: a case report

IntroductionCardiac ruptures following acute myocardial infarction include rupture of the left ventricle free-wall, ventricular septal defects, and papillary muscle rupture. Double myocardial rupture is a rare complication of acute myocardial infarction (0.3 %) and the report of such cases is exclusively limited to a small series of autopsy studies.Case presentationIn this report we present the unusual case of a 70-year-old woman with acute anteroseptal myocardial infarction, which was complicated by a combined rupture of the interventricular septum near the apex, and the free wall of the left ventricle with concomitant formation of a pseudoaneurysm. The double myocardial rupture was accidentally discovered 10 days later with echocardiography, when the patient, complaining only of mild exertional dyspnea, was hospitalized for a scheduled coronary angiography. The patient underwent successful surgical correction of the double myocardial rupture along with by-pass grafting.ConclusionThis report highlights the importance of comprehensive noninvasive predischarge diagnostic evaluation of all postinfarct patients, since serious and potentially life-threatening complications might have not been suspected on clinical grounds.

Left ventricle remodelling by double-patch sandwich technique

BackgroundThe sandwich double-patch technique was adopted as an alternative method for reconstruction of the left ventricle after excision of postinfarction dysfunctional myocardium to solve technical problems due to the thick edges of the ventricular wall.MethodsOver a 5-year period, 12 of 21 patients with postinfarction antero-apical left ventricular aneurysm had thick wall edges after wall excision. It was due to akinetic muscular thick tissue in 6 cases, while in the other 6 with classic fibrous aneurysm, thick edges remained after the cut of the border zone. The ventricular opening was sandwiched between two patches and this is a technique which is currently used for the treatment of the interventricular septum rupture. In our patients the patches are much smaller than the removed aneurysm and they were sutured simply by a single row of single stitches. However, in contrast to interventricular septum rupture where the patches loosen the tension of the tissues, in our patients the patches pull strongly and restrain the walls by fastening their edges and supporting tight stitches. In this way they could narrow the cavity and close the ventricle.ResultsThe resected area varied from 5 × 4 to 8 × 8 cm. Excision was extended into the interventricular septum in 5 patients, thus opening the right ventricle. CABG was performed on all patients but two. Left ventricular volumes and the ejection fraction changed significantly: end-systolic volume 93.5 ± 12.4 to 57.8 ± 8.9 ml, p < 0.001; end-diastolic volume 157.2 ± 16.7 to 115.3 ± 14.9 ml, p < 0.001; ejection fraction 40.3 ± 4.2 to 49.5 ± 5.7%, p < 0.001. All patients did well. One patient suffered from bleeding, which was not from the wall suture, and another had a left arm paresis. The post-operative hospital stay was 5 to 30 days with a mean 10.5 ± 7.5 days/patient. At follow-up, 9 to 60 months mean 34, all patients were symptom-free. NYHA class 2.5 ± 0.8 changed to 1.2 ± 0.4, p < 0.001.ConclusionThe double-patch sandwich technique (bi-patch closure) offers some advantages and does not result in increased morbidity and mortality. In the case of excising a left ventricular aneurysm, this technique in no way requires eversion of the edges, felt strips, buttressed and multiple sutures, all of which are needed for longitudinal linear closure. Moreover, it does not require purse string sutures, endocardial scar remnant to secure the patch or folding the excluded non-functional tissue, all of which are needed for endoventricular patch repair.

The enigma of optimal treatment for acute ventricular septal rupture

The enigma of optimal treatment for acute ventricular septal rupture

Surgical experience with left ventricular free wall rupture

Background. Autopsy studies reveal that left ventricular free wall rupture (LVFWR) accounts for 7% to 24% of deaths after myocardial infarction. The condition occurs up to 10 times more often than papillary muscle or interventricular septal rupture. A high index of suspicion must be maintained to differentiate LVFWR from infarct extension, cardiogenic shock, pulmonary embolus, and even Dressler’s syndrome.Methods. Since 1980, we have operated on 18 patients with LVFWR. Fourteen patients had experienced “blow-out” rupture associated with cardiogenic shock. Four patients had “stuttering” ruptures, a less spectacular occurrence. Echocardiography was the most important diagnostic tool. Repair was performed, usually using infarctectomy and direct suture closure.Results. Eleven patients (61%) died after operation, 4 patients as a result of rerupture 1 to 12 hours after operation. Recently, we have used a “patch/glue” technique to repair ruptures in 2 patients. We believe this technique is superior to direct suture closure in preventing rerupture. There have been 7 long-term survivors (39%) from 6 months to 15 years.Conclusions. Left ventricular free wall rupture is not always sudden and dramatic. Yet, the operating staff must be willing to race to the operating room even with the patient in full resuscitation. Echocardiography is the most sensitive and efficient diagnostic tool. All rupture sites should be aggressively repaired, possibly combining direct suture and patch/glue techniques.

A clinical dilemma: cardiac and pericardiac echinococcosis

Background. Cardiac and pericardial echinococcosis as a life-threatening disease may present with a clear picture most of the time, however it may also become a clinical puzzle. Methods. In the period between 1977 and 1998, 14 patients were operated on with the diagnosis of cardiac and pericardial echinococcosis. Nine patients were operated on with standard cardiopulmonary bypass (CPB) techniques, and the remaining 5 patients were operated on without CPB. Transesophageal echocardiography (TEE) or intraoperative surface echocardiography were used to plan and perform the operation for the late cases. Results. One patient died during the postoperative period due to the rupture of interventricular septum. All other patients survived the perioperative period, received mebendazole treatment, and exhibited no recurrence during the follow-up. Conclusions. The definitive treatment is the surgical extraction of the cyst. Because the clinical picture may vary according to the number, size, and location of cysts, as well as complications, cardiac echinococcosis should be remembered and included in the differential diagnosis to achieve the treatment. Intraoperative surface echocardiography is of paramount value for diagnosis and planning the management of a successful surgery.

Large Epicardial Lipoma Associated with Rupture of the Interventricular Septum after an Acute Myocardial Infarct

We report a case of a large epicardial lipoma associated with an unusual rupture of an infarcted interventricular septum. The proximity of the attachment of the lipoma to the rupture site, together with the unusual shape and location of the rupture, suggest that the lipoma perpetrated the rupture.

In-hospital outcome of elderly patients with acute inferior myocardial infarction and right ventricular involvement.

There are some specific high-risk subgroups of patients with acute inferior myocardial infarction, such as older patients and those with right ventricular involvement. However, the clinical implications of right ventricular infarction in elderly subjects have not been studied previously. To determine the clinical impact of right ventricular involvement in elderly patients with inferior myocardial infarction, we studied the in-hospital outcome of 198 consecutive patients > or = 75 years of age with a first acute inferior myocardial infarction according to the presence of ECG or echocardiographic criteria of right ventricular infarction. In patients with right ventricular involvement (41%), in-hospital case fatality rate was 47% (mainly because of nonreversible low cardiac output cardiogenic shock) compared with 10% in patients without right ventricular involvement (P<.001). Patients with right ventricular involvement also had a significantly higher incidence of cardiogenic shock (32% versus 5%), which was independent of left ventricular ejection fraction, complete AV block (33% versus 9%), and interventricular septal rupture (9% versus 0%). After adjustment for age, sex, diabetes, shock on admission, left ventricular systolic dysfunction, and complete AV block, right ventricular infarction remained a powerful independent predictor of in-hospital death (adjusted odds ratio, 4.0; 95% confidence interval, 1.3 to 14.2). Elderly patients with acute inferior myocardial infarction have a substantially increased risk of death during hospitalization when right ventricular involvement is present. The poorer outcome is due mainly to the high incidence of cardiogenic shock and its infrequent reversibility.

Three Different Coexisting Mechanical Complications of Myocardial Infarction Detected by Transthoracic and Transesophageal Echocardiography.

An aneurysm, pseudoaneurysm, and interventricular septal rupture were detected by transthoracic and transesophageal echocardiography (TEE) in a 61-year-old man with anterior myocardial infarction. This case illustrates the value of these techniques in the assessment of mechanical complications associated with myocardial infarction.

Echocardiographic Features of Ventricular Septal Rupture with Right Ventricular Aneurysm After Acute Myocardial Infarction.

Postinfarction ventricular septal defect is a life-threatening disorder that may be adequately treated if the diagnosis is obtained promptly. Two-dimensional color Doppler echocardiography is a reliable tool for this diagnosis and gives additional information regarding its location, size, and shape. The authors emphasize the feasibility of this method to depict a particular form of postinfarction interventricular septal rupture, which developed an aneurysm inside the right ventricular cavity. Its characteristics were completely defined by color Doppler echocardiography and confirmed at surgery. (ECHOCARDIOGRAPHY, Volume 13, May 1996)

Hemodynamic profile of a post-infarct ventricular septal defect: left atrial a-waves rather than v-waves may be a prominent feature

The presence of prominent left atrial v-waves following interventricular septal rupture in acute myocardial infarction have been reported in the past. Hemodynamic profile obtained in one particular case highlighted some of the varying aspects of pressure wave, oxygen saturation, and compliance abnormalities that may also be present in such cases. The presence of large left atrial a-waves rather than v-waves was one of the findings.

Prolonged Support with Intraaortic Balloon for Postinfarction Ventricular Septal Rupture

The optimal timing of repair in postinfarct interventricular septal rupture remains controversial. We report a 53-year-old man with a postinfarct ventricular septal defect sustained on intraaortic balloon pump for 20 days before successful surgical closure. In the presence of proponents of routine early closure of postinfarct ventricular septal defects the possibility of prolonged intraaortic balloon pump support to stabilize the patient must be kept in mind.

Temporary balloon closure of a postinfarction interventricular septal rupture

The technical aspects of temporary closure of a postinfarction interventricular septal rupture in a 76-year-old woman in critical circulatory status ruling out conservative therapy and making surgical management unfeasible, are described. The patient was in cardiogenic shock with hepatorenal failure in acute myocardial infarction of both the anterior and posterior walls. A balloon catheter developed in our unit was employed to close the rupture.

Pacemaker-Induced Friction Rub and Apical Thrill

A patient with acute myocardial infarction developed a loud systolic sound and apical thrill. Doppler ultrasound excluded interventricular septal rupture and significant mitral or tricuspid regurgitation. Auscultatory abnormalities disappeared after removal of a temporary pacing electrode, suggesting that the friction it created with intracardiac structures was responsible for these findings.

Interventricular Septum Rupture due to Falling from a Height

Non-penetrating traumatic interventricular septal rupture of the heart is rare. This lesion can result from blunt injuries, either immediate or delayed, but has never been reported from blunt chest trauma secondary to falling from height. Surgical repair can usually be done as an elective procedure with good results. However, with some patients early repair is necessary as a lifesaving measure. We report on a 15-year-old patient admitted after falling from the fourth floor with multiple bone fractures and blood pressure of 80/0. He soon required mechanical ventilation, but a heart murmur was only detected after some hours. On the fifth day a non-penetrating traumatic interventricular septal rupture became apparent, which was proved by echocardiography and Swan-Ganz catheterization. The patient underwent successful repair of the interventricular septal defect on the 13th day following injury. Two weeks later surgery for his bone fractures was carried out, after which the patient could be discharged uneventfully.

Diagnosis of recurrent rupture of interventricular septum during acute myocardial infarction by Doppler color flow mapping

This report presents a 60-year-old female who had acute anteroseptal myocardial infarction and a grade 3 6 pansystolic murmur at left lower sternal border. Color Doppler echocardiographic examination revealed the presence of a ventricular septal defect which was later confirmed by contrast left ventriculography and at the time of operation. Urgent operation with closure of ventricular septum was performed and the cardiac murmur disappeared. One day after operation a grade 3 6 pansystolic murmur at left lower sternal border was heard and hypotension was noted. Color Doppler echocardiographic examination demonstrated another ventricular septal defect. The patient underwent re-operation due to hemodynamic instability. At operation, a new ventricular septal defect was noted while the previous patch was intact.

Doppler echocardiographic features of ventricular septal rupture in myocardial infarction

Doppler echocardiography was used to evaluate the features of interventricular septal rupture in six patients with acute myocardial infarction and to substantiate the hemodynamic data and morphologic findings at surgery or autopsy. Although echocardiographic visualization of the septal rupture was obtained in only two of the six patients, unusual Doppler flow signals were detected in the apical portion of the right ventricle in all six patients. Five patients had unusual flow signals during both systole and diastole; one had such signals only during systole. The location of these unusual flow signals coincided with the site of septal rupture confirmed at surgery or autopsy. The pattern of the flow signals in one cardiac cycle was very similar to that of the pressure difference between the left and right ventricular cavities. These findings indicate that the unusual flow signals represent the left to right shunt flows resulting from septal rupture. In conclusion, Doppler echocardiography may be a very useful tool for diagnosing interventricular septal rupture easily and noninvasively in patients with acute myocardial infarction.

AIV-25 心筋梗塞後心筋破裂(心室中隔穿孔,心室自由壁破裂,乳頭筋断裂,仮性心室瘤)の外科治療

AIV-25 心筋梗塞後心筋破裂(心室中隔穿孔,心室自由壁破裂,乳頭筋断裂,仮性心室瘤)の外科治療

Echocardiographic findings of ventricular septal rupture in acute myocardial infarction

Echocardiograms were recorded both before and after the clinical appearance of an autopsy-confirmed interventricular septal rupture in a patient with an acute myocardial infarction. The major findings were related to the upper portion of the interventricular septum. Before rupture, this portion of the septum was relatively akinetic with a slight anterior motion during systole, whereas after rupture there was a marked increase in the amplitude of septal motion with abrupt posterior motion occurring with the onset of ventricular diastole.