Postinfarction Ventricular Septal Defect Research Articles

Veno-Arterial ECMO in the Setting of Post-Infarct Ventricular Septal Defect: A Bridge to Surgical Repair.

Extracorporeal membrane oxygenation (ECMO) is a complex rescue therapy utilised to provide circulatory and/or respiratory support to critically ill patients who have failed maximal conventional therapy. The use of ECMO in adult cardiac surgery is not routine, occurring in a minority of critically ill patients, typically postoperatively. Presented here are three cases of post-infarct ventricular septal defect with cardiogenic shock managed preoperatively with ECMO support as a bridge to definitive surgical closure. We present a review of ECMO in the adult cardiac surgical population and highlight the potential role of preoperative ECMO for cardiogenic shock in the setting of post-infarct ventricular septal defect (PI VSD) as a bridge to definitive closure.

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.

Interventional post-myocardial infarction ventricular septal defect closure: a systematic review of current evidence.

Interventional closure of post-myocardial infarction ventricular septal defects (VSD) is an alternative treatment option to surgical repair. However, only limited evidence exists concerning the interventional closure of a VSD. This review seeks to establish an overview of the existing literature and to carry out a systematic analysis of the success rate and clinical outcome of this procedure. We conducted a comprehensive systematic literature search to evaluate the existing evidence of percutaneous device closure of post-infarction VSD. Patient series with fewer than five reported cases were excluded. In total, 13 series were identified, with an overall inclusion of 273 patients. Mean patient age was 70 years. Cardiogenic shock was present in 48% of cases at the time of intervention. Device closure within the first 14 days (acute phase) after VSD detection was performed in 42% of cases. Technical success rate was high (>75%). Successful device implantation rate was 89%. Overall in-hospital/30-day mortality was 32%. Major complications included device embolisation, ventricular perfora-tion and arrhythmias. Percutaneous device closure of post-myocardial infarction VSD is a valuable alternative to surgical repair, with the advantage of immediate shunt reduction to prevent haemodynamic deterioration. A high rate of technically successful percutaneous procedures can be achieved; however, the mortality rate remains high, especially in cardiogenic shock patients.

Off-Pump Repair of a Post-Infarct Ventricular Septal Defect: How Safe Is the Hamburger Procedure With Oximetry Guidance?

We are reporting an off-pump technique for the surgical closure of a post-infarct ventricular septal defect (VSD). Our case report describes the case management of a 75-year-old man, who underwent the Hamburger procedure for the closure of his apical VSD. We are showing that oximetric guided off-pump posterior-anterior septal plication is a safe and effective method for closing post-infarct VSD in hemodynamically unstable patients in the absence of TOE. J Med Cases. 2016;7(5):168-170 doi: http://dx.doi.org/10.14740/jmc2476w

Miyokart İnfarktüsü Sonrası Geç Dönem Ventriküler Septal Defektin Cerrahi Onarımı

Miyokart İnfarktüsü Sonrası Geç Dönem Ventriküler Septal Defektin Cerrahi Onarımı

Early and midterm outcomes of triple patch technique for postinfarction ventricular septal defects

ObjectiveEarly and midterm outcomes were evaluated in patients who had postinfarction ventricular septal defect (VSD) and underwent VSD repair using the triple patch technique. MethodsTwenty-one patients underwent VSD repair for postinfarction VSD between April 2004 and September 2015. A retrospective analysis of all in-hospital and postdischarge data was performed. In addition, we compared pre- and perioperative variables between survivors and nonsurvivors. ResultsThirty-day mortality was 23.8% (5 patients). Three patients died due to low output syndrome and 2 patients died due to sepsis. All of these patients were in cardiogenic shock preoperatively. Although 3 patients had a small residual shunt after surgery, the residual shunt disappeared 6 months after surgery in 1 patient and has been decreasing gradually in another. The mean follow-up was 43.5 ± 36.1 months. Overall survival rates (Kaplan-Meier method) at 3 and 8 years were 70.8% and 57.9%, respectively. Compared with survivors, nonsurvivors had a higher incidence of preoperative cardiogenic shock, higher incidence of chronic kidney disease and end-organ failure, and longer aortic crossclamp times during surgery. ConclusionsEarly and midterm outcomes of modified infarct exclusion using the triple patch technique are acceptable. This technique is safe and simple, and may be useful for reducing postoperative residual shunt.

Long-term Results after Primary Surgical Repair of Post-infraction Ventricular Septal Defects: A Retrospective Single Centre Experience

Background: Postinfarction ventricular septal defect (pVSD) complicating acute myocardial infarction (AMI) still carries a high mortality. The aim of this single center study was to detect predictors for early and long-term outcome in patients undergoing primary surgical repair of pVSD managed by various surgical techniques.

Emergency Surgery after Unsuccessful Immediate Primary Percutaneous Post-infarction Ventricular Septal Defect Closure: A Single Center Case Series

Emergency Surgery after Unsuccessful Immediate Primary Percutaneous Post-infarction Ventricular Septal Defect Closure: A Single Center Case Series

APerventricular device closure of post-myocardial infarction ventricular septal defect: Can it combine best of both worlds!

Introduction: Post-myocardial infarction ventricular septal defect (VsD) is a rare but dreadful complication of acute myocardial infarction. current management of this complication has high morbidity and mortality rates. A hybrid approach (perventricular device closure) to high risk congenital muscular VsD has shown promising results. We report first case of a perventricular device closure of post infarct VsD by Amplatzer post-infarct muscular VsD device. case report: A 52-year-old male was referred to us for rapidly progressive dyspnea. He had anterior wall myocardial infarction, complicated by post-infarct VsD. His coronary angiography revealed 90% lesion in left anterior descending (LAD) artery. Perventricular device closure of VsD (Amplatzer post-infarct muscular VsD device) and graft to the LAD were performed using a beating heart technique. His postoperative stay was complicated by an enlarged secondary

Off-Pump Repair of a Post-Infarct Ventricular Septal Defect: How Safe Is the Hamburger Procedure With Oximetry Guidance?

Off-Pump Repair of a Post-Infarct Ventricular Septal Defect: How Safe Is the Hamburger Procedure With Oximetry Guidance?

心室中隔穿孔に対する外科治療

心室中隔穿孔に対する外科治療

Risk factors of mortality after surgical correction of ventricular septal defect following myocardial infarction: Retrospective analysis and review of the literature

BackgroundRupture of the ventricular septum following acute myocardial infarction (AMI) is an uncommon but serious complication, usually leading to congestive heart failure and cardiogenic shock. Surgical repair is the only definitive treatment for this condition. MethodsWe review our experience of surgical repair of post-infarction ventricular septal defects (VSDs), analyze the associated risk factors and outcomes, and do a complete review of the literature. A retrospective study was performed on 34 consecutive patients who had undergone surgical repair for VSDs following AMI from December 1991 to July 2014. Preoperative, clinical and echocardiographic variables were studied by uni-and multivariate analyses. ResultsMortality was analyzed for the entire group of patients. Mean age was 69±7years with 44% women. VSDs were anterior in 11 (32%) and posterior in 23 (68%) patients. A majority, 24 (71%) patients were in cardiogenic shock. Median interval from myocardial infarction to VSDs repair was 7days. The 30days operative mortality was 65%. Mortality within the posterior VSDs group was 74% and the anterior VSDs group was 46% (P=0.14). Concomitant coronary artery bypass graft (CABG) did not influence early or late survival. Multivariate analysis identified older age (HR=1.11, P=0.0001) and shorter time between AMI and surgery (HR=0.90, P=0.015) as independent predictors of 30-day and long-term mortality. ConclusionIn conclusion, surgical repair of post-AMI VSDs carries a high operative mortality. An algorithm of treatment for the management of these patients is suggested.

Surgical Outcomes of a Modified Infarct Exclusion Technique for Post-Infarction Ventricular Septal Defects.

BackgroundPostinfarction ventricular septal defects (pVSDs) are a serious complication of acute myocardial infarctions. The aim of this study was to analyze the clinical outcomes of the surgical treatment of pVSDs.MethodsThe medical records of 23 patients who underwent operations (infarct exclusion in 21 patients and patch closure in two patients) to treat acute pVSDs from 2001 to 2011 were analyzed. Intra-aortic balloon counter-pulsation was performed in 19 patients (82.6%), one of whom required extracorporeal membrane support due to cardiogenic shock. The mean follow-up duration was 26.2±18.6 months.ResultsThe in-hospital mortality rate was 4.3% (1/23). Residual shunts were found in seven patients and three patients required reoperation. One patient needed reoperation due to the transformation of an intracardiac hematoma into an abscess. No patients required reoperation due to recurrence of a ventricular septal defect during the follow-up period. The cumulative survival rate was 95.5% at one year, 82.0% at five years, and 65.6% at seven years.ConclusionThe use of a multiple-patch technique with sealants appears to be a reliable method of reducing early mortality and the risk of significant residual shunting in patients with pVSDs.

Transcatheter Closure of Postinfarction Ventricular Septal Defect: A short Report and Review of Literature

Transcatheter Closure of Postinfarction Ventricular Septal Defect: A short Report and Review of Literature

Iatrogenic embolization and transcatheter retrieval of a ventricular septal defect occluder in a dog

A 7-month-old Irish Setter underwent transcatheter therapy of a muscular ventricular septal defect (VSD) and pulmonary valve stenosis. Standard devices for muscular VSD closure could not span the interventricular septum due to right ventricular hypertrophy, and an Amplatzer post-infarction muscular VSD occluder with a wider waist was successfully implanted. Following VSD closure, inflation of the balloon dilation catheter during balloon pulmonary valvuloplasty resulted in iatrogenic embolization of the VSD occluder to the left ventricular outflow tract. Retrieval and reimplantation of the device was achieved using a snare catheter. This report describes a potential complication and management during intracardiac device implantation in a dog. Additionally, the case illustrates that the Amplatzer post-infarction muscular VSD occluder holds potential value in animals with a hypertrophied interventricular septum that cannot be spanned using a conventional device.

Surgical treatment of a rare form of multiple postinfarction ventricular septal defect

A case of successful treatment of a rare form of postinfarction ventricular septal defect presented as dissection and ventricular septal aneurysm in a 47-year female during 9-week follow-up is described.

Case report of combined correction of postinfarction ventricular septal defect

We present a case of successful combined correction (endovascular and surgical) of postinfarction ventricular septal defect in a woman at a late stage after acute myocardial infarction onset.

RISK FACTORS OF MORTALITY AFTER SURGICAL CORRECTION OF VENTRICULAR SEPTAL DEFECT FOLLOWING MYOCARDIAL INFARCTION

Rupture of the ventricular septum following myocardial infarction (MI) is an uncommon but serious complication, usually leading to congestive heart failure and cardiogenic shock. Surgical repair is the only definitive treatment for this condition but is associated with a high operative mortality. This study sought to analyze the associated risk factors and outcomes in this population. A retrospective review was performed on 34 consecutive patients who had undergone surgical repair of ventricular septal defect (VSD) following MI from December 1991 to June 2013. Preoperative, clinical and echocardiographic variables were analysis. Mean age was 69±5 years and 44% were females. The VSD was anterior in 11 (32%) and posterior in 23 (68%) patients. Twenty-four (71%) patients were in cardiogenic shock. Mean aortic cross clamp time was 94 minutes and mean cardiopulmonary bypass time was 141 minutes. Median interval from MI to VSD repair was 7 days. Overall operative mortality within 30 days was 65%. Mortality within the posterior VSD group was 74% and the anterior VSD group was 46% (p=0.1) Concomitant CABG did not influence early or late survival. Multivariate analysis identified age and time between MI and operation as independent predictors of 30-day and long-term mortality. Surgical repair of post-infarction VSD carries a high operative mortality. Age and time between MI and operation are independent predictors of 30-days and long-term mortality. In presence of such high-expected postoperative mortality with conventional surgery, alternative therapy may need to be considered (percutaneous VSD closure and heart transplant) especially in patients with posterior VSD.

Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects: The Mayo Clinic experience.

To determine event-free survival after transcatheter closure of ventricular septal defect (VSD), and to identify predictors of adverse events (AE) in post myocardial infarction VSD (post-MI VSD) subgroup. There are limited data on mid-term follow-up after transcatheter VSD closure. Retrospective review of 27 cases of transcatheter VSD closure (post-MI = 18 and non-ischemic = 9) performed from 1999 to 2013. We defined AE as death, device embolization, hemolysis requiring blood transfusion, heart block and reintervention. In the post-MI VSD subgroup, mean age and follow-up was 69 ± 11 and 7.3 ± 7 years, respectively. AE occurred in 8 (44%) patients (death-3, device embolization-1, hemolysis-1, surgical VSD closure-2, reintervention-1). Event-free survival was 56% at 1 month and 5 years, and all AE occurred in the periprocedural period. Cardiogenic shock (HR: 3.21, CI: 1.82-5.41, P = 0.002), and VSD closure in acute phase (HR: 2.14, CI: 1.12-4.31, P = 0.004) were independent predictors of AE. In the non-ischemic VSD subgroup, mean age and follow-up was 49 ± 15 and 8.7 ± 8 years, respectively. AE occurred in 3 (33%) patients (late death-1, surgical VSD closure-2). For the entire cohort, freedom from death was 89% and 85% at 1 month and 5 years, and event-free survival was 70% and 61% at 1 month and 5 years. Transcatheter closure of post-MI VSD carries a moderate risk of periprocedural complications but low event rates afterwards. By comparison, device closure of non-ischemic VSD has lower periprocedural morbidity but some patients continued to experience AE during follow-up.

"Sandwich Technique" via a Right Ventricle Incision to Repair Postinfarction Ventricular Septal Defects.

Residual shunting and mortality are problems associated with the current surgical repair techniques for postinfarction ventricular septal defects (VSD). We developed the "sandwich technique" via a right ventricle incision and assessed the surgical outcome of 13 years of experience with this technique. Between June 2001 and March 2013, 25 consecutive patients with postinfarction VSD underwent surgical repair using this technique. This technique includes the following: Application of direct ultrasonography to the right ventricular (RV) wall enables the surgeon to visualize the lesion, perform an appropriate incision into the RV, and perform a trabecular resection. One patch is placed on the left ventricular (LV) side and the other on the RV side of the VSD. The VSD is sealed with gelatin-resorcin-formalin (GRF) glue between the two patches. Thirty-day mortality was 0% (0/25 case). A postoperative major shunt occurred in three patients (12%, 3/25) and two of them required reoperation (8%, 2/25). Hospital mortality was 28% (seven patients). Mean follow-up period was 4.2 ± 3.7 years. The overall survival at one, five, and 10 years was 71 ± 9%, 65 ± 10%, and 56 ± 12%, respectively. There was no cardiac death during follow-up in the patients who survived for six months after the surgery. No tissue degeneration related to GRF glue was noted. The "sandwich technique" via a right ventricle incision results in a low incidence of postoperative leak and good short- and mid-term survival.