Myocardial Infarction Ventricular Septal Rupture Research Articles

Early outcome of surgical treatment of 20 cases of postinfartion ventricular septal rupture by extended sandwich patch technique via right ventricle approach

Objective: Different techniques have been described to repair post myocardial infarction ventricular septal rupture (VSR), each method may result in residual shunting, bleeding, and post-operative mortality. The aim of this report is to describe early results of extended sandwich technique through right ventricle in 20 consecutive patients.
 Patients and Methods: A retrospective, cross-sectional and descriptive study on 20 patients underwent surgery for myocardial infarction VSR by extended sandwich technique through right ventricle from 12/2018 to 3/2021 in Hanoi Heart Hospital.
 Result: 20 consecutive patients (10 women and 10 men) with postinfarction ventricular septal rupture (mean age 72 years, range 48-84) underwent surgical repair for by extended sandwich technique performed through right ventricle from December 2018 to August 2021 in our institute. Reconstruction of the septum was performed by two patches according to the method described by Asai et al. The mean aortic clamp time was 101. The mean extracorporeal circulation time was 143 min. Postoperative intensive care unit (ICU) stay averaged 4 days (range, 1-10 days). There was 30% hospital mortality. 10% postoperative residual shunting was detected, and no patient needed reoperation for bleeding.
 Conclusion: This method of extended sandwich technique through right ventricle was safe, simple, and it could be performed in acute phase of myocardial infarction.

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

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.

TCTAP C-109 Post Myocardial Infarction Ventricular Septal Rupture with Heart Failure Treated Successfully with Transcatheter Device Closure

TCTAP C-109 Post Myocardial Infarction Ventricular Septal Rupture with Heart Failure Treated Successfully with Transcatheter Device Closure

Neutrophil-to-Lymphocyte Ratio at Emergency Room Predicts Mechanical Complications of ST-segment Elevation Myocardial Infarction.

BackgroundThe neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI).MethodsA total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization.ResultsPatients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI (P = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136–3.339, P = 0.015) along with symptom-to balloon time (P = 0.002) and left ventricular dysfunction (P < 0.001).ConclusionNLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.

Report of five cases: sandwich repair for post infarction ventricular septal rupture with right ventricular approach

BackgroundDifferent techniques have been described to repair post myocardial infarction ventricular septal rupture (VSR), each method may result in residual shunting, bleeding, and suboptimal left ventricular (LV) performance secondary to change in LV geometry. The aim of this report is to describe early and mid-term results of sandwich technique through right ventricle in five consecutive patients.Case presentationFive consecutive patients (3 women and 2 men) with VSR (mean age 62.8 years, range 51-70) underwent surgical repair for postinfarction ventricular septal rupture by sandwich technique performed through right ventricle from August 2012 to April 2019 in our institute. Reconstruction of the septum was performed by two patches of 0.6 mm Gore-Tex on each side of the septal defect through right ventricular incision, according to the method described by Isoda et al. Coronary artery bypass grafting was performed in two patients.The mean aortic clamp time was 90 min (range, 64 to 157 min). The mean extracorporeal circulation time was 146.6 min (range, 108 to 240 min). Postoperative intensive care unit (ICU) stay averaged 12 days (range, 4-40 days). There was no hospital mortality. No postoperative residual shunting was detected, and no patient needed re-operation for bleeding. Patients have been followed up for a mean of 24.4 months (range, 1 week to 7 years). There was one death seven days after discharge due to arrhythmia (40 days after surgery).ConclusionSandwich technique through right ventricular approach is simple and extendable to all VSRs irrespective of their locations. Residual shunting and bleeding are negligible or zero. It may be considered as standard of repair for patient with post infarction ventricular septal rupture.

Early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal rupture

BackgroundPost myocardial infarction ventricular septal rupture (PMI-VSR) is a dreaded mechanical complication of acute coronary syndromes. Given that surgical mortality approaches 50%, it is pragmatic that the risk factors for mortality and outcomes after surgical correction of PMI- VSR are carefully scrutinized. MethodsWe performed a single-center, retrospective cohort study of 35 patients presenting for surgical closure of post myocardial infarction ventricular septal rupture over six years. We reviewed patient characteristics, clinical, echocardiographic, angiographic and perioperative risk factors which may affect mortality after surgical repair of PMIVSR and 30 day and one year mortality rates of these patients. Univariate and multivariate logistic and cox proportional hazard regression analysis was used to identify predictors of operative and overall mortality. Long term survival was presented with Kaplan-Meier Survival Curve. ResultsSixteen patients (46%) were in cardiogenic shock. Concomitant coronary artery bypass grafting (CABG) was done in 22 patients (63%) but did not influence survival. Preoperative thrombolysis was done in 12 patients (34%) out of which 10 (53%) survived Operative mortality was 46% and one-year mortality was 49%. Multivariate analysis identified preoperative thrombolysis: Hazards ratio, 0.12; 95% CI, 0.02-0.61; p value of 0.01, as significant independent predictor of survival in PMIVSR cohort. ConclusionsPreoperative thrombolysis is associated with decreased odds of operative and overall mortality after surgical repair in PMIVSR patients.

Post Myocardial Infarction Ventricular Septal Rupture, Early Surgery – Is It Beneficial?

Post Myocardial Infarction Ventricular Septal Rupture, Early Surgery – Is It Beneficial?

Surgical Repair of post-infarction ventricular septal rupture: Determinants of operative mortality and survival outcome analysis.

Background and Objective:Ventricular septal rupture (VSR) is one of the fatal complications of myocardial infarction (MI). Surgery provides the maximum survival benefit. Our objective was to investigate the risk factors of surgical mortality and to do the survival analysis in the past six years at our hospital.Methods:All the patients operated at CPE Institute of Cardiology Multan Pakistan, between 2009 and 2015 for repair of post MI VSR were analysed retrospectively for demographics, comorbidities, operative and post operative outcomes. The primary outcome was 30 days mortality. The follow up was done till April 2017 and the follow up data was obtained from hospital records and by telephoning the patients. SPSS was used for statistical analysis. P value < 0.05 was considered significant.Results:A total of 31 patients were operated for VSR repair with a mean age of 57.19±7.73 years. Eighteen patients also had a concomitant coronary artery bypass grafting (CABG). The operative mortality in this series was 25.8% Univariate analysis showed that pre-operative ejection fraction (E.F) (p value 0.010) and cardiogenic shock (p value 0.031) were a significant risk factors for operative mortality while on logistic regression analysis only the cardiogenic shock was found to be an independent risk factor for operative mortality with the odds ratio of 2.17. Low ejection fraction only acted as a confounding variable. The mean survival at six years was 34 months with a survival rate of 28.6%. The additional CABG did not confer any survival benefit.Conclusion:The patients in cardiogenic shock pre-operatively have a high operative mortality. Low ejection fraction (E.F) acts as a confounding factor. Concomitant CABG does not confer any survival benefit.

Effect of thrombolytic therapy on the patterns of post myocardial infarction ventricular septal rupture

ObjectivesVentricular septal rupture (VSR) is a rare but feared complication after myocardial infarction (MI). The objective of this study was to investigate the effects of thrombolytic therapy on the patterns of VSR following MI. Methods30 consecutive patients admitted to a single tertiary level cardiac hospital with a diagnosis of acute MI and developed VSR in the hospital were included. The effect on thrombolytic therapy on the formation of VSR and its clinical outcome was studied. ResultsOut of 30 patients, 15 patients received thrombolytic therapy.10 received early (<12h) and 5 received late (>12h). The median time to post MI VSR formation was significantly shorter in thrombolysis group compared to non thrombolysis group at 1 vs 3 days(p=0.026). The median time for VSR formation was shorter in early thrombolysis group compared to late thrombolysis group at 1 vs 3 days (p=0.022). There was no difference between late and no thrombolytic therapy (3 vs 3 days, p=0.672). There was no significant difference in the mortality between thrombolytic and no thrombolytic therapy (p=0.690). Patients treated medically had a significant higher mortality compared to patients treated surgically (p=0.005). ConclusionThrombolytic therapy results in an earlier presentation of VSR after MI. This earlier presentation may be due to reduction in the number of patients developing late VSR after thrombolytic therapy, while the number of patients developing an early VSR remaining unaffected. Despite improvements in medical therapy and percutaneous and surgical techniques, mortality with this complication remains extremely high.

Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas.

ObjectiveThe study aimed to identify the factors affecting the prognosis of post myocardial infarction (MI) ventricular septal rupture (VSR) and to develop a protocol for its management.MethodsThis was a single center, retrospective-prospective study (2009-2014), involving 55 patients with post MI VSR. The strengths of association between risk factors and prognosis were assessed using multivariate logistic regression analysis. The UNM Post MI VSR management and prognosis scoring systems (UPMS & UPPS) were developed.ResultsThirty-day mortality was 52.5% (35% in the last 3 years). Twenty-eight (70%) patients underwent concomitant coronary artery bypass grafting. Residual ventricular septal defect was found in 3 (7.5%) patients. The multivariate analysis showed low mean blood pressure with intra-aortic balloon pump (OR 11.43, P=0.001), higher EuroSCORE II (OR 7.47, P=0.006), higher Killip class (OR 27.95, P=0.00), and shorter intervals between MI and VSR (OR 7.90, P=0.005) as well as VSR and Surgery (OR 5.76, P=0.016) to be strong predictors of mortality. Concomitant coronary artery bypass grafting (P=0.17) and location (P=0.25) of VSR did not affect the outcome. Mean follow-up was 635.8±472.5 days and 17 out of 19 discharged patients were in NYHA class I-II.ConclusionThe UNM Post-MI VSR Scoring Systems (UPMS & UPPS) help in management and prognosis, respectively. They divide patients into 3 groups: 1) Immediate Surgery - Patients with scores of <25 require immediate surgery, preferably with extracorporeal membrane oxygenation support, and have poor prognosis; 2) Those with scores of 25-75 should be managed with "Optimal Delay" and they have intermediate outcomes; 3) Patients with scores of >75 can undergo Elective Repair and they are likely to have good outcomes.

Surgical Repair of Post Myocardial Infarction Ventricular Septal Rupture: Experience at a Tertiary Care Hospital

In recent years, transcatheter aortic valve implantation has become an emerging alternative for high-risk patients with severe aortic stenosis. We report a case of transcatheter aortic valve implantation with the self-expanding Medtronic CoreValve bioprosthesis through a left common carotid artery. This 83-year-old male patient presented with heart failure due to a severe degenerative aortic bioprosthesis, with several comorbidities, resulting in a logistic EuroScore II of 36%. Consequently, he was rejected to undergo surgery and a transcatheter approach was planned. And due to severe peripheral vascular disease with iliofemoral lesions, significant calcifications of the innominate artery, we considered a left carotid access through a prosthesis carotid in Dacron. The procedure was successful without cardiac, cerebrovascular, or access complications. And it appears to be a valuable alternative access for patients with severe peripheral vascular disease.

Grand Rounds - Hammersmith Hospital: Complicated myocardial infarction Ventricular septal rupture is a surgical emergency

Ventricular septal rupture is a serious complication of acute myocardial infarction that generally produces progressive circulatory failure and rapid deterioration. Prompt diagnosis followed by surgical repair with perioperative circulatory support is often life saving. We present the case of a patient with ventricular septal rupture who experienced recalcitrant attacks of sustained ventricular tachycardia postoperatively and discuss important aspects of management. A 64 year old woman was admitted with a three day history of severe retrosternal chest pain followed by progressively worsening dyspnoea at rest. Myocardial infarction was diagnosed, but the delay in admission precluded thrombolysis. Two days later she was transferred to this hospital with breathlessness and oliguria (480 ml over 24 hours) despite having been given intravenous diuretics and low dose dopamine. She had no history of heart disease or hypertension or known coronary risk factors. On examination she was unwell and mentally obtunded, with cool peripheries and a raised jugular venous pressure. The rhythm was sinus (rate 113 beats/min) and blood pressure 100/65 mm Hg. Her cardiac impulse was laterally displaced, and she had a loud pansystolic murmur, with a palpable thrill, at the lower left sternal border. Chest radiography showed cardiomegaly, and an electrocardiogram showed evidence of recent extensive anterior myocardial infarction with Q waves in leads V1-6. Her plasma sodium concentration was 123 mmol/l, urea concentration 46.5 mmol/l, and creatinine concentration 209 μmol/l. An echocardiogram showed anteroseptal-apical dyskinesia with infarct expansion, dilated ventricles and impaired biventricular function, and anteroapical septal rupture: colour Doppler ultrasound examination showed shunting and no evidence of mitral regurgitation (fig 1). Swan-Ganz catheterisation showed a pulmonary artery oxygen saturation of 88% and a pressure of 50/23 mm Hg. Ventricular septal rupture with incipient cardiogenic shock was diagnosed, and the circulation was supported with inotropic drugs and intra-aortic balloon counterpulsation pending emergency surgical …

心筋梗塞後心室中隔穿孔術後遠隔期の検討

心筋梗塞後心室中隔穿孔術後遠隔期の検討