Post-myocardial Infarction Ventricular Septal Defect Research Articles

Infarct exclusion repair of postmyocardial infarction ventricular septal rupture with a hybrid patch and septal occluder device compared with patch only

ObjectiveWe developed a hybrid technique for repairing post-myocardial infarction (MI) ventricular septal defect (VSD) that combines infarct exclusion with patch and a nitinol-mesh septal occluder device (SOD) to provide a scaffold to support the damaged septal wall. Here, we compare outcomes of patients with post-MI VSD repaired using patch only or hybrid patch/SOD. MethodsPatients undergoing post-MI VSD repair at our institution from 2013 to 2022 who received patch alone or patch/SOD repair were analyzed. Primary outcome was survival to hospital discharge. Clinical outcomes and echocardiograms were also analyzed. ResultsOver a 9-year period, 24 patients had post-MI VSD repair at our institution with either hybrid patch/SOD (n = 10) or patch only repair (n = 14). VSD size was 18 ± 5.8 mm for patch/SOD and 17 ± 4.6 mm for patch only. In the patch/SOD repair cohort, average size of SOD implant was 23.6 ± 5.6 mm. Mild left ventricular dysfunction was present prerepair and was unchanged postrepair in both groups; however, moderate-to-severe right ventricular (RV) dysfunction was common in both groups before repair. RV function worsened or persisted as severe in 10% of hybrid versus 54% of patch-only patients postrepair. Tricuspid annular systolic excursion and RV:left ventricle diameter ratio, quantitative metrics of RV function, improved after patch/SOD repair. No intraoperative mortality occurred in either group. Postoperative renal, hepatic, and respiratory failure requiring tracheostomy was common in both groups. Survival to hospital discharge in both cohorts was 70%. ConclusionsPost-MI VSD repair with patch/SOD has comparable short-term outcomes with patch alone. Addition of a SOD to patch repair provides a scaffold that may enhance the repair of post-MI VSD with patch exclusion.

Impella 5.5 support before, during, and after surgical ventricular septal defect repair: A bridge continuum.

Post-infarction ventricular septal defect formation remains a formidable mechanical complication of acute myocardial infarction associated with increased morbidity and mortality. We describe the case of a 72-year-old male who was admitted with post-myocardial infarction ventricular septal defect and cardiogenic shock. Impella 5.5 with SmartAssist as temporary left ventricular assist device provided sufficient support throughout multiple bridging episodes including failed percutaneous repair and subsequent definitive surgical repair. Contemporary management of post-infarction ventricular septal defect is discussed.

Double Device Approach for Percutaneous Closure of Postmyocardial Infarction Ventricular Septal Defect

The benefit related to the use of preprocedural computed tomography angiography (CCTA) on top of periprocedural echocardiography to plan percutaneous left atrial appendage closure (LAAC) procedures is still unclear.The authors sought to evaluate the impact of preprocedural CCTA on LAAC procedural success.In the investigator-initiated SWISS-APERO (Comparison of Amplatzer Amulet and Watchman Device in Patients Undergoing Left Atrial Appendage Closure) trial, patients undergoing echocardiography-guided LAAC were randomly assigned to receive the Amulet (Abbott) or Watchman 2.5/FLX (Boston Scientific) device across 8 European centers. According to the study protocol ongoing at the time of the procedure, the first operators had (CCTA unblinded group) or did not have (CCTA blinded group) access to preprocedural CCTA images. In this post hoc analysis, we compared blinded vs unblinded procedures in terms of procedural success defined as complete left atrial appendage occlusion as evaluated at the end of LAAC (short-term) or at the 45-day follow-up (long-term) without procedural-related complications.Among 219 LAACs preceded by CCTA, 92 (42.1%) and 127 (57.9%) were assigned to the CCTA unblinded and blinded group, respectively. After adjusting for confounders, operator unblinding to preprocedural CCTA remained associated with a higher rate of short-term procedural success (93.5% vs 81.1%; P = 0.009; adjusted OR: 2.76; 95% CI: 1.05-7.29; P = 0.040) and long-term procedural success (83.7% vs 72.4%; P = 0.050; adjusted OR: 2.12; 95% CI: 1.03-4.35; P = 0.041).In a prospective multicenter cohort of clinically indicated echocardiography-guided LAACs, unblinding of the first operators to preprocedural CCTA images was independently associated with a higher rate of both short- and long-term procedural success. Further studies are needed to better evaluate the impact of preprocedural CCTA on clinical outcomes.

Post-infarction ventricular septal defect surgery in Portugal

Introduction and ObjectiveWe performed a collective analysis of a dedicated national post-myocardial infarction ventricular septal defect (VSD) registry to further elucidate controversial areas of this clinical entity's surgical treatment. MethodsA descriptive statistical analysis was carried out and cumulative survival using the Kaplan-Meier method and multivariate logistic regression of risk factors for 30-day mortality are presented. ResultsMedian survival of the cohort (n=76) was 72 months (95% CI 4–144 months). Better cumulative survival was observed in patients who underwent VSD closure more than 10 days after myocardial infarction (log-rank p=0.036). Concomitant coronary artery bypass grafting (CABG), different closure techniques, location of the VSD, extracorporeal membrane oxygenation as bridge to closure, or intra-aortic balloon pump as bridge to closure showed no statistically significant differences at Kaplan-Meier analysis. Multivariate binary logistic regression for independent factors affecting status at 30 days showed a statistically significant effect of age (OR 1.08; 95% CI 1.01–1.15) and concomitant CABG (OR 0.23; 95% CI 0.06–0.90). ConclusionsOur results are comparable with previous reports regarding mortality, risk factors and concomitant procedures. Timing of surgery remains a controversial issue. Later closure seems to be advantageous, however, there is significant observational bias.

Postmyocardial infarction ventricular septal defect: too many doubts still to solve

Postmyocardial infarction ventricular septal defect: too many doubts still to solve

Management and Prognosis of Post-Myocardial Infarction Ventricular Septal Defect: A Case Series

Management and Prognosis of Post-Myocardial Infarction Ventricular Septal Defect: A Case Series

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

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

Management and outcomes of ventricular septal defects after acute myocardial infarction: A multicenter retrospective study.

The mortality rate of patients with post-myocardial infarction (MI) ventricular septal defects (VSDs) is high, and the benefit of surgery is unclear. We aimed to investigate the management and outcomes of post-MI VSD over a 10-year period in a large cohort. Data of patients with post-MI VSD admitted in three French university hospitals from 2008 to 2019 were examined. The characteristics of those who underwent surgery were compared with those who received medical treatment. Mortality risk factors, survival curves, and outcomes at 30 days and 1 year after treatment were determined. Of the 92 patients whose data were examined, 50 underwent surgery and 42 received exclusive medical treatment. All patients were critically ill. Overall, 76.1% of patients received inotropic support, and 63% received mechanical ventilation. Circulatory assistance, mainly via intra-aortic balloon pump and extra-corporeal membrane oxygenation, was provided to 46.7% patients, with 14.1% requiring a second assistance. The median time to surgery was 4 days. At 1 year, mortality was 46% in those who underwent surgery and 83.3% in those treated medically (p < .001). Survival curves at 1 and 3 months showed major differences, and the survival rate showed little change 30 days after treatment. Cardiogenic shock and cardiac arrest emerged as risk factors for mortality. In our retrospective, multicenter study, the mortality resulting from post-MI VSD did not seem to improve over the last decade. Although surgery carried considerable risks, it improved survival.

Abstract 15140: Post-Myocardial Infarction Ventricular Septal Defect in a Patient With Mixed Connective Tissue Disorder

Mixed connective tissue disorder (MCTD) is associated with a broad range of cardiovascular abnormalities, including coronary artery disease (CAD). It has been proposed that chronic systemic inflammation plays a key role in the development of atherosclerotic disease. A 66-year-old female with a history of MCTD and hypertension presented with mild dyspnea and pleuritic chest pain after one week of persistent flu-like symptoms. Her blood pressure was 108/77 mmHg, pulse 92 bpm, saturating 98% on room air. She was comfortable and denied other risk factors such as diabetes, hyperlipidemia, or prior smoking history. On exam she was found to have a soft holosystolic murmur across her precordium. EKG showed sinus rhythm with small Q waves and ST elevation in V1-V6. She was taken for cardiac catheterization which revealed a thrombotic occlusion in the proximal left anterior descending artery (LAD) and a severe lesion in the left circumflex artery. She underwent angioplasty with one drug eluted stent placed to LAD. Left ventriculography revealed a VSD near the apex, and transthoracic echocardiogram showed a 7.6 mm muscular VSD with left to right shunt, ejection fraction of 35% and hypokinesis of the anterior wall. She became hypotensive and required vasopressors prior to coronary artery bypass grafting and primary closure of her apical VSD. Intraoperatively, a 2 cm VSD with 5 cm of necrotic surrounding tissue was noted. Post-operative complications included asystolic cardiac arrest, marked cardiogenic shock and multiorgan failure to which she ultimately succumbed. Post-myocardial infarction VSD is a rare complication of MI occurring in approximately 0.2% of cases. However, patients with MCTD can develop atypical symptoms, resulting in delayed presentation and therefore higher risk of mechanical complications. We highlight the importance of a thorough physical exam and high suspicion for mechanical complications in these patients even when hemodynamically stable.

ANTERIOR ACUTE MYOCARDIAL INFARCTION COMPLICATED WITH VENTRICULAR SEPTAL RUPTURE: CASE REPORTS AND LITERATURE REVIEW

Post-myocardial infarction (MI)ventricular septal defect (VSD) is a mechanical complication that has become infrequent since the advent of reperfusion strategies however, it is associated with cardiogenic shock in 12% of cases and represents a significant mortality factor. Surgical treatment is often mandatory in the early period after anterior myocardial infarction(AMI) .Thus, early and appropriate management can reduce 30-40% mortality at 30 days.(1) We present three cases of anterior myocardial infarction complicated by apical VSD, emphasizing the major role of echocardiography in the diagnosis of this fatal complication.

Ventricular Septal Defect Post-Myocardial Infarction: About 5 Cases.

Post-myocardial infarction (MI) ventricular septal defect (VSD) is a rare but potentially catastrophic mechanical complication that occurs in less than 1% of patients following a myocardial infarction and it is associated with a high morbidity and mortality despite improvements in medical and surgical therapies of revascularization. Our article is based on the study of the occurrence of the VSD after a myocardial infarction in 5 patients. With an average age of 60 years, the prognosis was good if the rupture was small and the patient was hemodynamically stable. VSD tends to occur within the first week after acute myocardial infarction. In most cases, there is an immediate decline in hemodynamics which can lead to cardiogenic shock. VSD is a surgical emergency needing immediate treatment in symptomatic patients. The procedure requires the closure of the VSD and coronary artery bypass grafting.

Post-Myocardial Ventricular Septal Defect, Risk Factors and Epidemiological Aspects

Introduction and aims: Post-myocardial infarction ventricular septal defect is a rare dreadful complication of myocardial infarction. It usually occurs between the 3rd and 7th day of the infarction. Several risk factors for its occurrence have been identified. The aim of our work is to discuss these different risk factors through clinical cases with a literature review. Material and methods: This is a retrospective study conducted from 2015 to 2021 including 18 consecutive patients with post-myocardial ventricular septal defect presented in either cardiac intensive care unit or cardiac surgery department of Mohammed V Military Teaching Hospital Rabat. All patients had at least a clinical examination, an electrocardiogram, and an echocardiogram showing ventricular septal defect. Surgery was performed at cardiac surgery department. Results: Mean age was 65.2± 26.4 years. There were more men than women in our study (17 males/1 female). Diabetes (55.6%) and smoking (55.6%) were the two predominant cardiovascular risk factors. The average body mass index was 23.7 ± 2.98 kg/m². Anteroseptal was the most observed infarct location (38.9%.) 16 patients presented after 12 hours of pain onset. 2 of them underwent percutaneous intervention and 1 underwent coronary artery bypass graft intervention whereas 15 didn't undergo any revascularisation strategy. The culprit artery was left anterior descending artery in 13 patients. The death rate was 55.6%, 50% before surgery and 50% after surgery. Conclusion: Delayed or absence of coronary reperfusion remains the main risk factor for post-myocardial infarction ventricular septal defect occurrence which explains its frequency decline since reperfusion strategies development.

Use of Lumason Contrast Echocardiography in Post-myocardial Infarction Ventricular Septal Defect

We report herein the case of an elderly female who presented with myocardial infarction complicated by ventricular septal defect (VSD) that was evident on cardiac auscultation and contrast echocardiography using Lumason® (Bracco Diagnostics Inc, Monroe Township, USA). Patient underwent surgical repair for her VSD post-infarct along with coronary artery bypass grafting after being treated for cardiogenic shock. We also highlight the management strategies in patients with similar complications. In this report, we shed the light on the importance of using Lumason contrast for the identification of shunt and for the diagnosis of VSD. Lumason contrast is widely available and licensed.

Increased incidence of postmyocardial infarction ventricular septal defects during Covid‐19 pandemic: A case series

IntroductionVentricular septal defect (VSD) is one of the mechanical complications of acute myocardial infarction (MI), whose incidence has been decreasing throughout the years because of the emergence of different reperfusion therapy strategies.MethodsWe present a series of seven patients who underwent surgery for post‐MI VSD repair in our institution in the period between March 2020 and June 2021.DiscussionDuring the recent SARS‐COV2 pandemic, time to hospital admission increased due to patients being overcautious out of fear of exposing themselves to COVID‐19. The increased time to hospital admission, with associated late reperfusion therapy and delayed PCI, is closely related to an augmented incidence of post‐myocardial infarction mechanical complications such as ventricular septal defects. For this reason, we witnessed an increase in the incidence of post‐MI VSD.ConclusionFear of exposure to SARS‐COV2 in the medical environment was a major source of concern for all our patients. The target of hospital policy should be to reassure patients of freedom from COVID in the emergency department and cardiac wards in order to prevent such dreadful complications.

Postmyocardial infarction ventricular septal defect and ventricular aneurysm repair with a "double-patch frame" technique.

Postmyocardial infarction intraventricular septal rupture is a life-threatening medical condition. Surgical management of postmyocardial infarction ventricular septal defects (PIVSDs) is associated with a 60% mortality and a 40% incidence of residual ventricular septal defects (rVSDs). Our study aimed to describe our modification of the "Double-patch" technique of PIVSD repair without using a biological glue and present its postoperative complications and survival. This was a retrospective observational study. The Bakoulev's Scientific Center of Cardiac Surgery patient admission and discharge database was reviewed from March 2002 to April 2021. The inclusion criterion was PIVSD. Exclusion criteria were conservative treatment, transcatheter closure of PIVSD, PIVSD closure with an interventricular septum patch, and chronic PIVSDs. The study outcomes were echocardiographic parameters of cardiac function, postoperative complications, and mortality. Forty nine patients met the study eligibility criteria. Comparison of echocardiographic data of cardiac function demonstrated reduction in the postoperative period end-diastolic (201.4 ± 59.6 ml vs. 118 [range: 76-207] ml; p < .0005) and end-systolic volumes (106 [51-208] ml vs. 66 [40-147] ml; p < .0005). One (2%) patient developed hemodynamically significant rVSD that required the second run of cardiopulmonary bypass and rVSD closure. Thirteen (26.5%) patients died in the hospital. The overall mortality rate for the study period was 11.4/100 person-years (95% confidence interval [CI]: 6.9-19.0/100 person-years). In these patients, 1-year survival was 68.2% (95% CI: 52.3%-79.8%) and 5-year survival was 63.1% (95% CI: 45.1%-76.7%). The "Double-patch frame" technique restores LV dimensions, has a low rate of hemodynamically significant rVSDs and mortality.

Transcatheter Closure of a Ragged Post-Myocardial Infarction Ventricular Septal Defect Using an Off-Label ASD Occluder

Post-myocardial infarction ventricular septal defect has become a rare event following ST Elevation Myocardial Infarction (STEMI) but is still a life-threatening complication with high mortality. Transcatheter closure of post-myocardial infarction ventricular septal defects has emerged as an alternative therapeutic approach but often requires individual strategies due to complex morphology. We report a case of a 62-year-old man who was admitted to our hospital after STEMI of the inferior wall with pulmonary congestion due to a post-myocardial infarction VSD for interdisciplinary evaluation and therapy. The patient was characterized by estimated high perioperative risk and underwent interventional closure of the VSD according to heart team decision. Because of ragged nature of the VSD closure with a conventional Occlutech™ VSD occluder was not possible. Therefore, we decided to close the defect using an off-lable device for ASD closure which was successfully implanted without relevant residual shunt.

Multi-modality imaging of post-myocardial infarction ventricular septal defect associated to basal inferoseptal pseudoaneurysm.

Multi-modality imaging of post-myocardial infarction ventricular septal defect associated to basal inferoseptal pseudoaneurysm.

Analysis of Predictors of 30-Day Mortality for Patients Undergoing Surgical Repair of Post-Myocardial Infarction Ventricular Septal Defect

Aims: Despite the existence of numerous studies devoted to predictors of 30-day mortality in patients with post-myocardial infarction (MI) ventricular septum defect (VSD), the choice of surgical treatment tactics for post-MI VSD remains an item of discussion. The purpose of the research was to determine the most significant risk factors of 30-day mortality in patients with post-MI VSD in order to optimize the tactics of such patients’ surgical repair.&#x0D; Study design: The retrospective analysis of the results of a comprehensive examination and surgical treatment of 88 in-patients with post-MI VSD for the period of 2002-2019 was carried out.&#x0D; Results: As follows of the research findings, independent predictors of 30-day mortality in patients with post-MI VSD were determined. The predictors identified were combined into a Scoring system to stratify the risk of surgical failure in patients with post-MI VSD. Modelling the surgery outcomes makes it possible to optimize the tactics of surgical treatment of patients with post-MI VSD.&#x0D; Conclusion: we have identified the most significant predictors of 30-day mortality in patients with post-MI VSD. The Score designed for mortality risk assessment is easy in use compared to other existing tools used in clinical practices when planning the surgical intervention in post-MI VSD patients. This Score may allow the stratification of post-MI VSD patients.

Advantages of intraoperative implantation of Impella 5.5 SmartAssist in the Management of Acute Post-Infarction Ventricular Septal Defect with cardiogenic shock

BackgroundDespite advances in surgical techniques and aggressive therapy of post-infarction ventricular septal defect (VSD) with cardiogenic shock, the overall morbidity and mortality is frustratingly high. The Impella 5.5 SmartAssist (Abiomed, Danvers, MA) is a surgically implanted temporary device, recently approved by the FDA (https://www.businesswire.com/news/home/20190925005454/en/) for treatment of patients in cardiogenic shock, and may fill a technological gap for patients who require acute circulatory support after VSD closure.Case presentationWe report our initial experience for two patients with post myocardial infarction VSD in the setting of cardiogenic shock supported with trans-aortic implantation Impella 5.5 SmartAssist. First patient had a posterior VSD with a left to right shunt (Qp/Qs ratio of 3.3), blood pressure 80/35 mmHg, right ventricle dysfunction, severe pulmonary arterial hypertension (an estimated systolic pulmonary artery pressure of 45 mmHg), and severe mitral valve regurgitation. Second patient was admitted for massive MI with large anterior VSD (Qp/Qs ratio of 2.8). Under cardiopulmonary bypass with cardioplegic arrest both patients underwent urgent VSD closure with trans-aortic implantation of the Impella. Minimal postoperative support was required. Patients were discharged on postoperative day 10 and 14 and remained well 3 months later. Follow-up echocardiogram showed no residual shunt.ConclusionsEarly surgical implantation of Impella 5.5 SmartAssist can prevent multiorgan dysfunction and stabilize the patients in cardiogenic shock with post-myocardial infarction VSD.

Mortality and risk factors after a surgical repair of postinfarction ventricular septal defect

Background The aim of this study was to present our experience in the treatment of post-myocardial infarction ventricular septal defect and examine the various risk factors. Methods This is a retrospective study. From January 2010 to December 2018, 20 patients underwent an urgent /emergency surgical repair of post-myocardial infarction ventricular septal defect. Results The mortality in our group of patients was 45 %. Non-survivors compared to the survivors were all in cardiogenic shock (p=0.0098), had an emergency/salvage operation (p=0.0055), preoperative mechanical ventilation (p=0.0081), shorter time between intraaortic balloon pressure insertion and surgery (p=0.0115), shorter median time between ventricular septal defect and surgery, postoperative renal replacement therapy (p=0.0498), and more patients had a residual effect (p=0.0022). In multivariate analysis, preoperative mechanical ventilation (p=0.0001), postoperative renal replacement therapy (p=0.0021) and residual defect (p=0.0000027) were shown to be strong predictors for hospital mortality. Conclusion This analysis showed that post-myocardial infarction ventricular septal defect repair is a devastating complication and preoperative mechanical ventilation, postoperative renal replacement therapy and residual defect were identified to be the predictors of mortality. Initial stabilization of the patients, when it is possible, and a delayed repair, may improve the outcome of these patients (Tab. 3, Ref. 17).