Post-myocardial Infarction Ventricular Septal Rupture Research Articles

Perioperative Challenges and Outcome After Surgical Correction of Post-myocardial Infarction Ventricular Septal Rupture: A Retrospective Single Center Study.

Ventricular septal rupture (VSR) is a rare but grave complication of acute myocardial infarction (AMI). It is a mechanical complication of myocardial infarction where patients may present either in a compensated state or in cardiogenic shock. The aim of the study is to determine the in-hospital mortality. The study also aims to identify the predictors of outcomes (in-hospital mortality, vasoactive inotrope score (VIS), duration of ICU stay and mechanical ventilation in the postoperative period) and compare the clinical and surgical parameters between survivors and non-survivors. This is a retrospective study. The data of 90 patients was collected from the medical records and the data comprising of 13 patients who underwent VSR closure by single patch technique, or septal occluder, and those who expired before receiving the treatment, was excluded. The data of 77 patients diagnosed with post-AMI VSR and who underwent surgical closure of VSR by double patch technique was included in this study. Clinical findings and echocardiography parameters were recorded from the perioperative period. The statistical software used was SPSS version 27. The primary outcome was determining the in-hospital mortality. The secondary outcome was identifying the clinical parameters that are significantly more in the non-survivors, and the factors predicting the in-hopsital mortality and morbidity (increased duration of ICU stay, and of mechanical ventilation, postoperative requirement of high doses of vasopressors and inotropes). Subgroup analysis was done to identify the relation of various clinical parameters with the postoperative complications. The factors predicting the in-hospital mortality were illustrated by a forest plot. The mean age of the patients was 60.35 (±9.9) years, 56 (72.7%) were males, and 21 (27.3%) were females. Requirement of mechanical ventilation preoperatively (OR 3.92 [CI 2.91-6.96]), cardiogenic shock at presentation (OR 4 [CI 2.33 - 6.85]), requirement of IABP (OR 2.05 [CI 1.38-3.94]), were predictors of mortality. The apical location of VSR had been favorable for survival. The EUROScore II at presentation correlated with the postoperative VIS (level of significance [LS] 0.0011, R 0.36. The in-hospital mortality in this study was 33.76%. The in-hospital mortality of VSR is 33.76%. Cardiogenic shock at presentation, non-apical site of VSR, preoperative requirement of mechanical ventilation, high VIS preoperatively, perioperative utilization of IABP, prolonged CPB time, postoperative duration of mechanical ventilation, and high postoperative VIS were the factors associated with increased odds of in-hospital mortality.

Impella Support for Postmyocardial Infarction Ventricular Septal Rupture.

Impella Support for Postmyocardial Infarction Ventricular Septal Rupture.

Role of ECLS in Managing Post-Myocardial Infarction Ventricular Septal Rupture.

The aim of this study was to analyze outcomes in patients undergoing surgery for ventricular septal rupture (VSR) after myocardial infarction (MI) and the preoperative use of extracorporeal life support (ECLS) as a bridge to surgery. We included patients undergoing surgery for VSR from January 2009 until June 2021 from two centers in Germany. Patients were separated into two groups, those with and without ECLS, before surgery. Pre- and intraoperative data, outcome, and survival during follow-up were evaluated. A total of 47 consecutive patients were included. Twenty-five patients were in the ECLS group, and 22 were in the group without ECLS. All the ECLS-group patients were in cardiogenic shock preoperatively. Most patients in the ECLS group were transferred from another hospital [n = 21 (84%) vs. no-ECLS (n = 12 (57.1%), p = 0.05]. We observed a higher number of postoperative bleeding complications favoring the group without ECLS [n = 6 (28.6%) vs. n = 16 (64%), p < 0.05]. There was no significant difference in the persistence of residual ventricular septal defect (VSD) between groups [ECLS n = 4 (16.7%) and no-ECLS n = 3 (13.6%)], p = 1.0. Total in-hospital mortality was 38.3%. There was no significant difference in in-hospital mortality [n = 6 (27.3%) vs. n = 12 (48%), p = 0.11] and survival at last follow-up between the groups (p = 0.50). We detected no statistical difference in the in-hospital and long-term mortality in patients who received ECLS as supportive therapy after MI-induced VSR compared to those without ECLS. ECLS could be an effective procedure applied as a bridge to surgery in patients with VSR and cardiogenic shock.

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

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

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.

Clinical assessment of VSR site and size and its relation to the severity of heart failure in post-myocardial infarction ventricular septal rupture patients.

Ventricular septal rupture (VSR) is a rare but well-known mechanical consequence of an acute myocardial infarction (AMI). Even in the later stages of re-perfusion therapy, the result of VSR remains poor. Our aim is to assess the site and size of VSR in relation to the severity of cardiac failure. From January 2016 to December 2022, a total of 71 patients with a diagnosis of post-myocardial infarction VSR were admitted to the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. Data records were retrospectively included in this registry. In all patients, clinical and echocardiographic data were gathered, and statistical analyses were performed. A total of 71 consecutive patients (mean age: 66.27 ± 8.88 years); 50.7% male, 49.3% female, with (M:F) ratio of almost (1:1). Left ventricular ejection fraction (LVEF) was (48.55 ± 10.44%) on echocardiography, and apical VSR was the most common site (69.0%). Overall, the VSD site was strongly related to the VSD size (p = .016), LVEF (p = .012), AMI site (p = .001), and affected coronary vessel (p = .004). Prodromal angina (p = .041), intra-aortic balloon pump (p = .002), affected coronary vessels (p = .020), pro-BNP (p = .000), and LVEF (p = .017) were predictors of the severity of heart failure. Diabetes mellitus is a common risk factor for post-myocardial infarction VSR. VSR site and size had no relation to the severity of heart failure. A presentation with prodromal angina predicted severe heart failure and a worse prognosis.

Early surgical outcomes of a modified infarct exclusion technique in acute post-myocardial infarction ventricular septal rupture: a single-centre experience.

Operative mortality in an acute post-myocardial infarction (AMI) ventricular septal rupture (VSR) is high. In addition to ventricular dysfunction, friable myocardium adds to the technical difficulty of the operation. In a modified infarct exclusion technique, the right ventricle is left undisturbed and the free edge of the pericardial patch is incorporated in the sutures while closing the left ventriculotomy. This simplifies the procedure and decreases the chances of right ventricular dysfunction, any residual defect, and bleeding. A retrospective analysis of patients with VSR following AMI operated in our institute from January 2018 to June 2021 was done. Over the last 3years, 16 patients with AMI VSR were treated with a modified infarct exclusion technique. Eight patients presented in cardiogenic shock preoperatively and were put on intra-aortic balloon pump support. All patients could be weaned successfully from the cardiopulmonary bypass, no patient had any residual defect, and none of the patients required re-exploration for bleeding. Postoperatively, 5 patients died within the first week and 2 more patients subsequently died due to intractable arrhythmias over the next 30days. In our centre, the mortality following repair of VSR after AMI was 43%. The modified infarct exclusion technique is a good technique with less chances of postoperative re-exploration and residual defect.

Unruptured Ventricular Septal Dissection Complicating Anterior Wall Myocardial Infarction

Interventricular septal dissection is a rare Complication of the interventricular septum. It may result from an aneurysm of the sinuses of Valsalva, bacterial endocarditis, trauma, cardiac surgery, Myocardial infarction, endomyocardial biopsy, or a congenital myocardial developmental anomaly. Postmyocardial infarction ventricular septal rupture (VSR) is a rare complication (1/1000), and ventricular septal dissection is an even less common complication with only five case reports previously described, But unruptured post Myocardial Infarction (MI) dissection is even rarer with only one reported study before. In this case report we describe an unruptured post-MI Interventricular septal dissection following anterior wall MI.

Survival in Patients with Post-myocardial Infarction Ventricular Septal Rupture: A Retrospective Observational Study

Introduction: Post-myocardial infarction ventricular septal rupture (post-MI-VSR) is a dreaded complication with high mortality. There is a varied survival pattern among patients who have undergone surgical repair. Aim: To assess the survival rates in patients who underwent surgical repair for post-MI-VSR in a single centre. Materials and Methods: A retrospective observational study was conducted in the Department of Cardiothoracic Surgery at Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India. The patient records from January 2005 to December 2020, who underwent surgical repair of postMI-VSR, were reviewed. The perioperative variables, mortality, and survival data were analysed. Kaplan-Meier analysis was performed to assess the survival time. Results: The mean age of the studied patients was 58.4±7.5 years. A total of 73 patients underwent surgery for post-MIVSR. A total of 40 (55.80%) were males and 33 (45.20%) were females. Overall, 36 (49.32%) patients had diabetes, and 27 (36.99%) had hypertension. Anterior Myocardial Infarction (MI) (n=56, 76.71%) was the most common location of MI. The mean Cardiopulmonary Bypass (CPB) and clamp times were 144.05±59.09 and 105.38±38.34 minutes, respectively. The mean survival time was 2619.564 days {95% Confidence Interval (CI) 2105.936 to 3133.192}. Conclusions: As revascularisation confers a significant survival advantage, VSR repair with concomitant Coronary Artery Bypass Graft (CABG) appears beneficial.

Miyokard İnfarktüsü Sonrası Gelişen Ventriküler Septal Rüptürün Transkateter Kapatılması Sırasında Amplatzer Septal Okluderin Sağ Ventriküler Diskinde Oluşan Kobra Başı Deformitesi

In the modern era of reperfusion therapy, the incidence of post-myocardial infarction ventricular septal rupture has dramatically decreased by <1%, but unfortunately, it is still associated with high morbidity and mortality despite improvements in medical and surgical therapies. Percutaneous device closure of post-myocardial infarction ventricular septal rupture may be an alternative to surgical repair, with the advantage of immediate shunt reduction to prevent hemodynamic deterioration, especially in high-risk patients. Herein we report a case of post-myocardial infarction ventricular septal rupture which was successfully closed with an amplatzer atrial septal occluder device accompanied by cobrahead deformity in the right ventricular disc.

LEFT VENTRICULAR ANEURYSM AND VENTRICULAR SEPTAL DEFECT FOLLOWING MYOCARDIAL INFARCTION: A DANGEROUS COCKTAIL

An ischemic ventricular septal defect (VSD) is a lethal complication of myocardial infarction (MI), commonly from 24 hours to up to 5 days of presentation with AMI. Despite the improvement of surgical techniques, the mortality is still very high with poor prognosis. Left ventricular aneurysm (LVA) may also be a fatal mechanical complication of MI but rarely occurs in the posterior or inferior portion of the interventricular septum. Concomitant AMI mechanical complications in the same patient are less than infrequent with poor prognosis, particularly with late hospital arrival. We present an unusual case of post-myocardial infarction ventricular septal rupture (PI-VSR) combined with left ventricular inferior/inferoseptal aneurysm that was managed surgically. The aim of this article is to make clinician alerted in case of mechanical complication, especially when post-MI patients become hemodynamically unstable with refractory congestive heart failure.

A new surgical technique for post-myocardial infarction ventricular septal rupture with hemodynamic instability.

A new surgical technique for post-myocardial infarction ventricular septal rupture with hemodynamic instability.

Successful Treatment of Post-Myocardial Infarction Ventricular Septal Rupture.

Successful Treatment of Post-Myocardial Infarction Ventricular Septal Rupture.

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.

Postmyocardial infarction ventricular septal rupture as a potentially fatal complication: when time is the best medicine

A 78-year-old man was urgently referred to the Department of Cardiology of our hospital with a ventricular septal rupture (VSR) secondary to a myocardial infarction (MI). Three weeks prior to...

A Case Report: Point-of-care Ultrasound in the Diagnosis of Post-Myocardial Infarction Ventricular Septal Rupture.

IntroductionVentricular septal rupture (VSR) is a rare complication of ST-elevation myocardial infarction (STEMI), typically discovered post-revascularization.Case reportWe present the first case of VSR detected on point-of-care ultrasound (POCUS) in the emergency department immediately prior to emergent angiography, with management positively affected by this discovery. The VSR was quickly confirmed via right heart catheterization. Subsequently, hemodynamic stability was achieved using an intra-aortic balloon pump. A delayed surgical VSR repair, with concomitant coronary artery bypass grafting, was implemented for definitive management.ConclusionThis case highlights the utility of POCUS in a STEMI patient with a suspected mechanical complication.

Device closure of postmyocardial infarction ventricular septal rupture – Winning the battle but losing the war!

Ventricular septal rupture (VSR) after acute myocardial infarction is rare and associated with high mortality despite surgical repair. Percutaneous transcatheter device closure has emerged as an alternative to surgical repair in high-risk patients or as a bridge to delayed surgical repair. Not only the timing but also the morphology of defect matters, and in patients with serpiginous ventricular septal defect, device deployment is challenging. We report a patient with cardiogenic shock due to serpiginous VSR following myocardial infarction who underwent percutaneous transcatheter device closure successfully but expired on the 3rd day following the procedure due to sepsis and multiorgan failure.

Post-myocardial infarction ventricular septal rupture in a patient with large secundum atrial septal defect: a case report.

BackgroundVentricular septal rupture (VSR) is an uncommon but potentially fatal complication of acute myocardial infarction (AMI). The management of VSR is challenging, and its surgical correction is associated with the highest mortality among all cardiac surgery procedures.Case summaryA 57-year-old man with a history of smoking presented with AMI with a large apical VSR in addition to a large secundum atrial septal defect (ASD). His left ventricular ejection fraction was 30%, and the right ventricle was moderately dilated with normal systolic function. Cardiac catheterization revealed that the left anterior descending artery was diffusely diseased with total mid occlusion, whereas other coronary arteries had non-obstructive disease. This unique combination resulted in distinctive presentation with paradoxically better outcomes. After stabilization, the patient’s interventricular septum was reconstructed, and the ASD was closed with a pericardial patch. The post-operative period was uneventful, and the patient was discharged 1 week after surgery. A follow-up echocardiography revealed no residual shunt.DiscussionPost-myocardial infarction VSR presents differently in patients with pre-existing right ventricular volume overload. In such cases, the absence of significant cardiogenic shock at presentation may result in better surgical outcomes.

Early and late mortality and morbidity after post-MI ventricular septal rupture repair: predictors, strategies, and results.

There has been a shift in the paradigm of management of post-myocardial infarction ventricular septal rupture (MI VSR), with many authors reporting improved prognosis if the surgery can be "optimally delayed." Timing of the procedure is of critical importance and our management (UPMS), and prognosis scores (UPPS) have proven to be relevant. However, long-term outcomes and their correlation with our scores had not been analyzed. In this study, we present our long-term results of post-MI-VSR repair and their correlation with our prognosis score (UPPS). Seventy-one patients with post-MI VSR repair (2009-2017) were retrospectively studied. Patients were managed using standard institute protocols. The 30-day mortality was 56% (n = 40). During a mean follow-up of 4.91 ± 2.43years, there were eight late deaths. Actuarial survival of 30-day survivors was 87% at 1year, 74% at 5years, and 69% at 10years. Actuarial freedom from major adverse cardiovascular events (MACE) was 82% at 1year, 72% at 2years, and 72% at 8years. The UPPS score predicts late mortality with sensitivity of 75% and negative predictive value of 84%. Our prognostic score (UPPS) helps not only in predicting early mortality but also in identifying the patients who are likely to live longer. The management score (UPMS) also provides best timing for the procedure, which is helpful in optimal utilization of resources in the developing world. The accuracy of these scores is reasonable and may be helpful in the decision-making in this difficult subset.

Primary transcatheter closure of post-myocardial infarction ventricular septal rupture using amplatzer atrial septal occlusion device: A study from tertiary care in South India

ObjectiveThe study investigated effectiveness of transcatheter closure of post-myocardial infarction (MI) ventricular septal rupture (VSR) using atrial septal device (ASD) occluder in a cohort of patients admitted at our institute. MethodThis was a retrospective, observational and single center study, which included patients who were treated with transcatheter closure for post-MI VSR at our tertiary care center between May 2000 and August 2014 depending upon inclusion and exclusion criteria. Primary outcome was all-cause mortality at 30-days follow-up. The MELD-XI (Model for End Stage Liver Disease) score was used as a predictor for poor outcome in these patients. ResultsA total of 21 patients (mean age 66.4±5.9years) were included in the study. Study cohort predominantly included male patients (n=15; 71.4%) and patients with single vessel disease (n=15; 71.4%). Revascularization of the culprit lesion, before VSR closure, was attempted in 6 patients. Except one patient (treated with Cera® occluder), all patients were treated with Amplatzer® ASD occluders. Average diameter of VSR was 20.8±6.9mm. Diameter of the device used in the study ranged from 10mm to 30mm. Residual defect was detected in 13 patients (62%). All-cause mortality at 30-day follow-up was observed in 9 (42.9%) patients. Time to VSR closure, diameter of VSR, and serum creatinine levels were significantly related to the 30-day mortality. MELD-XI score was found to be strongly associated with increased risk of mortality. ConclusionPrimary transcatheter VSR closure using ASD occluders is a feasible approach which can provide reasonable survival outcomes along with equitable mortality rates.