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Wang W, Feng Y, Lin X, Wu X, Chen G, Ma R, Guan X. Massive post-infarction ventricular septal rupture complicaing cardiogenic shock with long term veno-arterial extracorporeal membrane oxygenation support. Perfusion 2024; 39:603-606. [PMID: 36541675 DOI: 10.1177/02676591221147426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a rare but serious complication often causing cardiogenic shock (CS). The timing of surgery is a difficult problem for surgeons because of high mortality and surgical complexity. We present a case of successful use of extracorporeal membrane oxygenation (ECMO) for maintaining haemodynamic stability preoperative and delaying surgical repair of VSR patient in severe CS. CASE REPORT A 57-year-old man with AMI complicated by severe CS due to an massive VSR. Emergency surgery was considered a too high mortality risk. The patient was implanted with a percutaneous veno-arterial ECMO (VA-ECMO) system as a bridge to surgery for stabilizing general condition. On the 31th day after ECMO implantation, the ventricular septal defect was successfully repaired and weaning from the ECMO. DISCUSSION This case study illustrates that it may be considered to use long term ECMO preoperative to delayed surgery which leads to higher survival in cases of massive VSR patient after AMI in hemodynamically compromised patients. Still the optimal duration of mechanical circulatory support and the optimal timing for surgery need more research to define. CONCLUSION This case indicates the feasibility of preoperative using of a long term VA-ECMO as a bridge to surgical repair of VSR patient after AMI in severe CS. The optimal duration of mechanical circulatory support and the optimal timing for surgery still require further investigation.
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Affiliation(s)
- Wei Wang
- Department of Cardiopulmonary Bypass, Lanzhou University Second Hospital, Lanzhou, China
| | - Ying Feng
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xin Lin
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiangyang Wu
- Department of Cardiovascular Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Gang Chen
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Ruchao Ma
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xinqiang Guan
- Department of Cardiovascular Surgery, Lanzhou University Second Hospital, Lanzhou, China
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2
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Öztürk C, Ustabaşıoğlu FE. Apical thrombus mimicking ventricular septal rupture. J Invasive Cardiol 2024. [PMID: 38471157 DOI: 10.25270/jic/24.00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
A 51-year-old man with chest pain was admitted to the emergency department. The patient was taken to the coronary angiography lab with a diagnosis of inferior myocardial infarction.
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Affiliation(s)
- Cihan Öztürk
- Department of Cardiology, Trakya University Faculty of Medicine, Edirne, Turkey.
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3
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Tomotsuka S, Ikeda T, Ide Y, Baba S, Hirata T, Minatoya K. Surgical treatment for a child with traumatic ventricular septal rupture and ventricular aneurysm. Asian Cardiovasc Thorac Ann 2024; 32:140-142. [PMID: 38478425 DOI: 10.1177/02184923241236996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
A five-year-old boy was diagnosed with the ventricular septal rupture and ventricular aneurysm after blunt chest trauma in child abuse. Because of the intractable heart failure, he underwent operation in subacute period. Postoperative course was uneventful. The blunt cardiac injury in children can be caused by mild trauma and can be lethal. Surgical intervention should be considered when the clinical condition is unstable.
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Affiliation(s)
- Sanae Tomotsuka
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadashi Ikeda
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yujiro Ide
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shiro Baba
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuya Hirata
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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4
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Kwok CS, Qureshi AI, Will M, Schwarz K, Lip GYH, Borovac JA. Structural Complications Following ST-Elevation Myocardial Infarction: An Analysis of the National Inpatient Sample 2016 to 2020. J Cardiovasc Dev Dis 2024; 11:59. [PMID: 38392273 PMCID: PMC10889581 DOI: 10.3390/jcdd11020059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
ST-elevation myocardial infarction (STEMI) is a life-threatening emergency that can result in cardiac structural complications without timely revascularization. A retrospective study from the National Inpatient Sample included all patients with a diagnosis of STEMI between 2016 and 2020. Primary outcomes of interest were in-hospital mortality, length of stay (LoS), and healthcare costs for patients with and without structural complications. There were 994,300 hospital admissions included in the analysis (median age 64 years and 32.2% female). Structural complications occurred in 0.78% of patients. There was a three-fold increase in patients with cardiogenic shock (41.6% vs. 13.6%) and in-hospital mortality (30.6% vs. 10.7%) in the group with structural complications. The median LoS was longer (5 days vs. 3 days), and the median cost was significantly greater (USD 32,436 vs. USD 20,241) for patients with structural complications. After adjustments, in-hospital mortality was significantly greater for patients with structural complications (OR 1.99, 95% CI 1.73-2.30), and both LoS and costs were greater. There was a significant increase in mortality with ruptured cardiac wall (OR 9.16, 95% CI 5.91-14.20), hemopericardium (OR 3.20, 95% CI 1.91-5.35), and ventricular septal rupture (OR 2.57, 95% CI 1.98-3.35) compared with those with no complication. In conclusion, structural complications in STEMI patients are rare but potentially catastrophic events.
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Affiliation(s)
- Chun Shing Kwok
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO 65211, USA
| | - Maximillian Will
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, 3100 Krems, Austria
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, 3100 St. Poelten, Austria
| | - Konstantin Schwarz
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, 3100 Krems, Austria
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University & Liverpool Heart and Chest Hospital, Liverpool L69 3BX, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Josip A Borovac
- Division of Interventional Cardiology, Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
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5
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Ghosh A, Sekar A, Saravanan S, Sriram CS, Pandurangi UM. An unusual site of ablation for a ventricular tachycardia. J Arrhythm 2024; 40:160-165. [PMID: 38333384 PMCID: PMC10848586 DOI: 10.1002/joa3.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/18/2023] [Accepted: 10/28/2023] [Indexed: 02/10/2024] Open
Abstract
Scar-related ventricular tachycardia (VT) ablation involves localizing the critical isthmuses by overdrive pacing maneuvers and three-dimensional activation mapping. Implantable prosthetic devices have been known to complicate this by covering sites of potential isthmuses. We herein present a sentinel report of scar-VT ablation with a protected isthmus localized over an endothelialized post-myocardial infarction ventricular septal defect occluder device.
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Affiliation(s)
- Anindya Ghosh
- Department of Cardiac Electrophysiology and Pacing, Arrhythmia Heart Failure AcademyThe Madras Medical MissionChennaiTamil NaduIndia
| | - Anbarasan Sekar
- Department of Cardiac Electrophysiology and Pacing, Arrhythmia Heart Failure AcademyThe Madras Medical MissionChennaiTamil NaduIndia
| | | | - Chenni S. Sriram
- Division of CardiologySub‐section of Electrophysiology, Children's Hospital of Michigan and Detroit Medical CenterDetroitMichiganUSA
| | - Ulhas M. Pandurangi
- Department of Cardiac Electrophysiology and Pacing, Arrhythmia Heart Failure AcademyThe Madras Medical MissionChennaiTamil NaduIndia
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6
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Machii Y, Taoka M, Hayashi Y, Harada A, Kamata K, Tanaka M. Delayed Giant Pseudoaneurysm With Left-to-Right Shunt Following Postinfarct Ventricular Septal Perforation Repair. Tex Heart Inst J 2023; 50:e238269. [PMID: 38073437 PMCID: PMC10751473 DOI: 10.14503/thij-23-8269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Left ventricular pseudoaneurysm with a left-to-right shunt is extremely rare, requiring surgery if symptomatic; however, surgery has a high risk. Here, the case of a 77-year-old man with heart failure symptoms is reported, in which he develops a giant left ventricular pseudoaneurysm 16 months after ventricular septal perforation repair as a result of acute myocardial infarction, with mild shunt blood flow from the pseudoaneurysm to the right ventricle. Intraoperative findings showed a free wall rupture along the area where the patch was secured during the initial surgery. The patient was discharged on postoperative day 13, and postoperative examination revealed no abnormalities.
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Affiliation(s)
- Yojiro Machii
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Taoka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yuki Hayashi
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Harada
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Keita Kamata
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masashi Tanaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
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7
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Rojas-Espinoza M, Aguilar-Mejía C, Muñoz-Moreno JM. Post-myocardial Infarction Ventricular Septal Rupture Complicated by Cardiogenic Shock Stage D: A Successful Case of Extracorporeal Membrane Oxygenation as a Bridge to Delayed Surgical Repair. Cureus 2023; 15:e50574. [PMID: 38222231 PMCID: PMC10788080 DOI: 10.7759/cureus.50574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Ventricular septal rupture (VSR) after myocardial infarction is often complicated by cardiogenic shock (CS) with high in-hospital mortality rates. Early use of preoperative venoarterial extracorporeal membrane oxygenation (VA ECMO) and delayed surgical repair have demonstrated lower mortality rates; however, the optimal timing of surgical intervention remains controversial. We report the case of a 53-year-old man with CS stage D due to post-myocardial infarction VSR, who was successfully treated with VA ECMO as a bridge to delayed surgical repair. This case highlights the complexity of determining the optimal timing for surgical intervention in these patients and emphasizes the benefits of early use of VA ECMO for preoperative stabilization in patients with CS and multiorgan failure.
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8
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Tong L, Wu L, Dong N. Extracorporeal Left Ventricular Assist Device as a Bridge to Surgery for Ventricular Septal Rupture After Acute Myocardial Infarction. Patient Prefer Adherence 2023; 17:2871-2876. [PMID: 38027088 PMCID: PMC10640820 DOI: 10.2147/ppa.s436512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Ventricular septal rupture (VSR) after acute myocardial infarction (AMI) is a rare but often fatal complication. Surgery is considered the preferred treatment, although the optimal timing is discussed. The immediate preoperative hemodynamic status significantly impacts postoperative outcomes, making mechanical circulatory support (MCS) devices crucial for perioperative hemodynamic stability. We present the case of a 61-year-old woman with no remarkable cardiological history admitted to our hospital with a diagnosis of AMI and VSR. Due to hemodynamic instability and cardiogenic shock, we utilized an intra-aortic balloon pump (IABP) and an extracorporeal left ventricular assist device (extra-VAD) as a bridge to surgery. After 17 days of IABP support, the patient experienced hemodynamic instability, elevated lactate levels, pulmonary edema, and eventually bedside endotracheal infiltration inventor-assisted breathing. Subsequently, the IABP was removed, and the patient underwent 6 days of extra-VAD therapy, resulting in hemodynamic stability, a decline in lactate levels, and a reduction in pulmonary edema on X-ray. Surgical coronary artery bypass grafting and VSR repair were successfully performed without periprocedural complications, and the patient was subsequently discharged. Extra-VAD is useful for serious cardiogenic shock in patients with VSR after AMI and may be considered a reasonable approach as a bridge to surgery.
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Affiliation(s)
- Lu Tong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Long Wu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
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9
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Sandoval Boburg R, Kondov S, Karamitev M, Schlensak C, Berger R, Haeberle H, Jost W, Fagu A, Beyersdorf F, Kreibich M, Czerny M, Siepe M. Role of ECLS in Managing Post-Myocardial Infarction Ventricular Septal Rupture. J Cardiovasc Dev Dis 2023; 10:446. [PMID: 37998504 PMCID: PMC10672658 DOI: 10.3390/jcdd10110446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Rodrigo Sandoval Boburg
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, 79106 Freiburg, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, 79106 Freiburg, Germany
| | - Mladen Karamitev
- Medical Faculty, Albert-Ludwigs-University Freiburg, 79106 Freiburg, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Rafal Berger
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Helene Haeberle
- Department of Anesthesiology and Critical Care Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Walter Jost
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Albi Fagu
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, 79106 Freiburg, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, 79106 Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, 79106 Freiburg, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, 79106 Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, 79106 Freiburg, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, 79106 Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, 79106 Freiburg, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, 79106 Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, 79106 Freiburg, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, 79106 Freiburg, Germany
- Department of Heart Surgery, Cardiovascular Center, Inselspital, 3010 Bern, Switzerland
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Konishi T, Funayama N, Yamamoto T, Hotta D, Tanaka S. Lethal complication: Ventricular septal perforation and right ventricular infarction after acute myocardial infarction. Clin Case Rep 2023; 11:e7994. [PMID: 37850060 PMCID: PMC10577155 DOI: 10.1002/ccr3.7994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023] Open
Abstract
Here, we report a case of ventricular septal perforation complicated with right ventricular infarction after inferior acute myocardial infarction, which was associated with a poor clinical outcome despite the successful surgical treatment.
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Affiliation(s)
- Takao Konishi
- Department of Cardiovascular Medicine, Faculty of Medicine, and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Naohiro Funayama
- Department of CardiologyHokkaido Cardiovascular HospitalSapporoJapan
| | - Tadashi Yamamoto
- Department of CardiologyHokkaido Cardiovascular HospitalSapporoJapan
| | - Daisuke Hotta
- Department of CardiologyHokkaido Cardiovascular HospitalSapporoJapan
| | - Shinya Tanaka
- Department of Cancer Pathology, Faculty of MedicineHokkaido UniversitySapporoJapan
- Institute for Chemical Reaction Design and Discovery (WPI‐ICReDD), Hokkaido UniversitySapporoJapan
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11
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Morton KF, Hasnie UA, Prime D, Still SA, McElwee S. A Case of Post-Myocardial Infarction Ventricular Septal Rupture Complicated by Postoperative Septal Rupture. JACC Case Rep 2023; 22:101996. [PMID: 37790765 PMCID: PMC10544302 DOI: 10.1016/j.jaccas.2023.101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 10/05/2023]
Abstract
We present the case of a 60-year-old man who presented with a post-myocardial infarction ventricular septal rupture caused by a delayed presentation of myocardial infarction. Despite revascularization, hemodynamic stability, and a 10-day delay until operative management to allow for tissue healing, the patient experienced a fatal recurrent postoperative ventricular septal rupture. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Kara F. Morton
- Department of Medicine, Heersink School of Medicine at the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Usman A. Hasnie
- Division of Cardiovascular Disease, Heersink School of Medicine at the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Darryl Prime
- Division of Cardiovascular Disease, Heersink School of Medicine at the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sasha A. Still
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Samuel McElwee
- Division of Cardiovascular Disease, Heersink School of Medicine at the University of Alabama at Birmingham, Birmingham, Alabama, USA
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12
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Garg P, Lykins A, Alomari M, Pollak P, Patel P, Sareyyupoglu B. Case report: Heart transplant for persistent right heart failure after complete surgical repair and percutaneous closure of post-myocardial infarction ventricular septal rupture. Front Cardiovasc Med 2023; 10:1237772. [PMID: 37790593 PMCID: PMC10543756 DOI: 10.3389/fcvm.2023.1237772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
The incidence of post-acute myocardial infarction ventricular septal rupture (post-AMI VSR) has decreased; however, mortality after surgical repair of post-AMI VSR remains high. Patients who are not surgical candidates can be managed by heart transplant with a good outcome. A heart transplant in a patient after successful repair of VSR has never been reported. We report a patient who had persistent right heart failure after the successful repair of VSR and underwent a heart transplant with a good outcome.
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Affiliation(s)
- Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Amy Lykins
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Peter Pollak
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida
| | - Parag Patel
- Department of Transplant, Division of Advanced Heart Failure and Cardiac Transplant, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
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13
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Tanto IV, Dharma S, Juzar DA, Bono AA. Ventricular Septal Rupture Complicating an Acute ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic. Int J Angiol 2023; 32:194-196. [PMID: 37576532 PMCID: PMC10421677 DOI: 10.1055/s-0040-1720971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/17/2020] [Indexed: 10/22/2022] Open
Abstract
Ventricular septal rupture (VSR) is rare but a lethal complication of acute myocardial infarction (MI). Definite treatment requires the surgical closure of the VSR and coronary artery bypass grafting (CABG). However, the optimal timing for surgery is still controversial, particularly during the novel coronavirus disease 2019 (COVID-19) pandemic where medical procedures should be performed within the safest environment. Before surgery, a proper management in the intensive cardiovascular care unit is essential to maintain the stability of the hemodynamic profile related with VSR and determines the prognosis of the patient. We described a case of VSR complicating an anterior wall MI in a patient who admitted to our hospital during the COVID-19 pandemic that was treated successfully by surgical closure of the VSR and CABG.
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Affiliation(s)
- Ines V. Tanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dafsah A. Juzar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Arinto A.H. Bono
- Division of Cardiothoracic and Vascular Surgery, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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14
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Nobah AMA, Abuheit EMI, Jian L, Wang X, Zhang Y. Clinical assessment of VSR site and size and its relation to the severity of heart failure in post-myocardial infarction ventricular septal rupture patients. Clin Cardiol 2023; 46:981-988. [PMID: 37340690 PMCID: PMC10436785 DOI: 10.1002/clc.24062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/25/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Ali Mansour Ali Nobah
- Department of CardiologyFirst Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Ezaldin M. I. Abuheit
- Department of CardiologySecond Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Liguo Jian
- Department of CardiologySecond Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Xiaofang Wang
- Department of CardiologySecond Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Yanzhou Zhang
- Department of CardiologyFirst Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
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15
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Drissa M, Azaiez F, Jaoued F, Khelifa R, Lagha E, Romdhane RB, Tlili R, Ameur YB. A rare case of concurrent left ventricular aneurysm and ventricular septal rupture complicating an inferior myocardial infarction: a case report. Pan Afr Med J 2023; 45:74. [PMID: 37663629 PMCID: PMC10474810 DOI: 10.11604/pamj.2023.45.74.39612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/07/2023] [Indexed: 09/05/2023] Open
Abstract
Complications following acute myocardial infarction (MI) such as ventricular septal rupture (VSR) and left ventricular (LV) aneurysm are rare and can be dreadful. Their simultaneous presence in the same patient is extremely rare. We aimed to present a rare case of concomitant association of ventricular aneurysm and VSR complicating an inferior myocardial infarction. We report the unusual case of Mr. A. D, a 63-year-old, active smoker, with a history of diabetes mellitus and hypertension, admitted for the management of inferior MI within 6 days. The MI was complicated by an LV aneurysm in the inferoposterior and the inferoseptal walls associated with a VSR in the inferoseptal wall. The patient had only signs of right heart failure on admission. This observation illustrates on the one hand the rarity of the association of VSR and LV aneurysm after an inferior myocardial infarction, and on the other hand the possibility of founding them at an early stage of MI without any signs of cardiogenic shock.
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Affiliation(s)
- Mariem Drissa
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
| | - Fares Azaiez
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
| | - Fekher Jaoued
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
| | - Rouaida Khelifa
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
| | - Elyes Lagha
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
| | | | - Rami Tlili
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
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16
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Okam NA, Vargas J, Mohamed Jiffry MZ, Ahmed-Khan MA, Carmona Pires F, Ibe U. Postinfarction Ventricular Septal Ruptures During the COVID-19 Pandemic: Two Case Series. Cureus 2023; 15:e40331. [PMID: 37448387 PMCID: PMC10338133 DOI: 10.7759/cureus.40331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
This case series highlights the occurrence of hemodynamically significant ventricular septal defects (VSDs) in two patients presenting with ST-elevation myocardial infarction (STEMI) during the COVID-19 pandemic. This paper aims to emphasize the delayed presentation of cardiac emergencies, such as STEMI, due to concerns about contracting COVID-19. This delay has led to an increased risk of rare complications, including VSD, associated with STEMI. The first case involves a 92-year-old male with a history of hypertension, hyperlipidemia, chronic kidney disease, and coronary artery disease. He presented with acute chest pain, and diagnostic tests revealed ST elevations and a VSD. Despite intervention efforts, including hemodynamic support, the patient's condition deteriorated, and he passed away due to advanced age and high surgical risk. The second case involves a 62-year-old female with a medical history of diabetes, hypertension, and hyperlipidemia. She presented with left-sided chest pain, and an angiogram revealed a mid-right coronary artery stenosis and a thrombus. During the procedure, the patient experienced hypotension, requiring hemodynamic support. Subsequent evaluations identified a large VSD with right ventricular dysfunction. The patient underwent a series of interventions, including a ventricular assist device and VSD closure, but experienced multi-organ failure and ultimately passed away. VSDs following acute myocardial infarction (MI) are rare but life-threatening complications. Early revascularization is crucial in preventing the development of VSDs. These cases demonstrate the importance of prompt diagnosis and intervention, as delayed presentation increases the risk of mechanical complications. Surgical closure remains the definitive treatment for postinfarction VSDs.
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Affiliation(s)
- Nkechi A Okam
- Department of Internal Medicine, Danbury Hospital, Yale School of Medicine, Danbury, USA
| | - Jonathan Vargas
- Department of Internal Medicine, Danbury Hospital, Yale School of Medicine, Danbury, USA
| | | | - Mohammad A Ahmed-Khan
- Department of Internal Medicine, University of Vermont, Burlington, USA
- Department of Internal Medicine, Danbury Hospital, Yale School of Medicine, Danbury, USA
| | - Felipe Carmona Pires
- Department of Internal Medicine, Danbury Hospital, Yale School of Medicine, Danbury, USA
| | - Uzochukwu Ibe
- Department of Cardiology, Danbury Hospital, Yale School of Medicine, Danbury, USA
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17
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Tripathi A, Bisht H, Arya A, Konat A, Patel D, Patel J, Godhani D, Mozumder K, Parikh D, Jain P, Sharma K. Ventricular Septal Rupture Management in Patients With Acute Myocardial Infarction: A Review. Cureus 2023; 15:e40390. [PMID: 37456418 PMCID: PMC10345166 DOI: 10.7759/cureus.40390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Untreated myocardial infarction (MI) can potentially lead to many fatal complications which require immediate management. One of them is ventricular septal rupture (VSR) which necessitates the hemodynamic stabilization and closure of the septal rupture. Conventional treatment strategy involves surgical repair; however, percutaneous transcatheter repair using an occluder device is a promising upcoming approach. We conducted a detailed review of various published articles and examined the trends in incidence, risk factors, and pathophysiology of MI leading to VSR followed by an in-depth analysis of the various management strategies for the same. In the current clinical scenario, thrombolysis is an imperative management strategy that has been shown to decrease the occurrence of VSR by manifolds, more specifically in patients having ST-elevated MI. Delayed surgical closure remains the main treatment for post-infarction VSR. Other newer modalities, such as percutaneous closure devices and mechanical circulatory supports, are attractive alternative or complementary strategies to treat such patients, both postoperatively and perioperatively. However, earlier surgical repair in VSR increases the risk of mortality, and the optimal timing for VSR closure remains controversial. Despite surgical closure of VSR being the traditional treatment, it presents a considerably high operative risk. Although newer interventions such as percutaneous closure devices and mechanical circulatory supports provide impressive outcomes, their efficacy in high-risk patients remains inconclusive.
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Affiliation(s)
| | - Himanshi Bisht
- Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Akshat Arya
- Internal Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Ashwati Konat
- Department of Zoology, Biomedical Technology and Human Genetics, Gujarat University, Ahmedabad, IND
| | - Divya Patel
- Internal Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Jay Patel
- Internal Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Dhruvin Godhani
- Trauma and Orthopaedics, Gujarat Medical Education and Research Society Medical College, Gandhinagar, IND
| | - Kamalika Mozumder
- Internal Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Dhyey Parikh
- Internal Medicine, Gujarat Medical Education and Research Society Medical College, Gandhinagar, IND
| | - Pragya Jain
- Internal Medicine, Smt Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Kamal Sharma
- Cardiology, Dr. Kamal Sharma Cardiology Clinic, Ahmedabad, IND
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18
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Cadogan D, Daghem M, Snosi M, Williams LK, Weir-McCall J, Calvert PA, Giblett JP. Percutaneous Transcatheter Closure of Post-infarction Ventricular Septal Defect: An Alternative to Surgical Intervention. Interv Cardiol 2023; 18:e19. [PMID: 37435604 PMCID: PMC10331564 DOI: 10.15420/icr.2023.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/03/2023] [Indexed: 07/13/2023] Open
Abstract
Post-infarction ventricular septal defect is a mechanical complication of acute MI. The incidence of this complication is low in the primary percutaneous coronary intervention era. However, the associated mortality is very high at 94% with medical management alone. Open surgical repair or percutaneous transcatheter closure still has an in-hospital mortality >40%. Retrospective comparisons between both closure methods are limited by observation and selection bias. This review addresses the assessment and optimisation of patients prior to repair, the optimal timing of repair, and the limitations in current data. The review considers techniques for percutaneous closure, and finally considers the path that future research should take to improve outcomes for patients.
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Affiliation(s)
- Diarmaid Cadogan
- Department of Cardiology, Liverpool Heart and Chest HospitalLiverpool, UK
| | - Marwa Daghem
- Department of Cardiology, Liverpool Heart and Chest HospitalLiverpool, UK
| | - Mostafa Snosi
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest HospitalUK
| | | | - Jonathan Weir-McCall
- Department of Radiology, Royal Papworth HospitalCambridge, UK
- Division of Cardiovascular Medicine, University of CambridgeCambridge, UK
| | - Patrick A Calvert
- Department of Cardiology, Royal Papworth HospitalCambridge, UK
- Division of Cardiovascular Medicine, University of CambridgeCambridge, UK
| | - Joel P Giblett
- Department of Cardiology, Liverpool Heart and Chest HospitalLiverpool, UK
- Liverpool Centre for Cardiovascular Science, University of LiverpoolLiverpool, UK
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19
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Chen T, Liu Y, Zhang J, Sun Z, Han Y, Gao C. Percutaneous closure of ventricular septal rupture after myocardial infarction: A retrospective study of 81 cases. Clin Cardiol 2023. [PMID: 37190920 DOI: 10.1002/clc.24027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/09/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of percutaneous closure of ventricular septal rupture (VSR) after acute myocardial infarction (AMI). METHODS This retrospective study included 81 patients who underwent transcatheter closure for postinfarction VSR. We analyzed clinical data from hospitalization and the 30-day follow-up, compared clinical data from the survival and death groups, and explored the best closure time and the safety and efficacy of occlusion. The risk factors for death at 30 days were analyzed by logistic regression. RESULTS C-reactive protein (CRP), white blood cell counts, N-terminal pro brain natriuretic peptide (NT-ProBNP), and aspartate aminotransferase were higher in the death group than in the survival group (p < .01), with a higher rate of application of vasoactive drugs, and a shorter time from AMI to operation (p < .05). At 30 days postocclusion, 19 patients (23.5%) had died. The mortality rate was significantly lower for operation performed 3 weeks after AMI than for operation performed within 3 weeks of AMI (12.5% vs. 48%, p < .001). Devices were successfully implanted in 76 patients, with 16 (21.1%) operation-related complications and 12 (15.8%) valve injuries. Cardiac function improved significantly (p < .001) at discharge (N = 66) and 30 days after procedure (N = 62). Qp/Qs and pulmonary artery systolic pressure decreased significantly, while aortic systolic pressure increased significantly (p < .001). Additionally, EF and LVDd improved (p < .05) after occlusion. Increases in CRP and NT-ProBNP were risk factors for death at 30 days after closure (p < .05). CONCLUSION Percutaneous VSR closure can be a valuable treatment option for suitable patients with VSR.
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Affiliation(s)
- Tongfeng Chen
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuhao Liu
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Zhang
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Zirui Sun
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Han
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Chuanyu Gao
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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20
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Sarkar S, Agrawal G, Khadse S, Chaturvedi A. Persistent Winking Coronary Sign in a Case of Post-myocardial Infarction Ventricular Septal Rupture After Device Closure. Cureus 2023; 15:e39167. [PMID: 37332463 PMCID: PMC10276187 DOI: 10.7759/cureus.39167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
A winking coronary sign refers to the partial collapse of an artery situated over the ventricular septal rupture during systole and refilling of the same during diastole, which is seen as phasic filling and disappearance of the arterial segment during coronary angiography. In this article, we discuss the case of a patient who reported to the emergency department of a tertiary care hospital in central India with myocardial infarction of the anterior wall. Two-dimensional echocardiography and coronary angiography revealed ventricular septal rupture. The patient was promptly managed by a percutaneous coronary angiography and interventricular septal device closure. Even after the defect closure, the winking coronary sign persisted on coronary angiography, and the patient was then discharged in stable condition.
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Affiliation(s)
- Souvik Sarkar
- Respiratory Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gajendra Agrawal
- Cardiology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Satish Khadse
- Cardiology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anuj Chaturvedi
- Cardiology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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21
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Ascaso M, Quintana E. Ventricular Septal Rupture After Mitral Surgery: Blood Always Finds Its Course. Eur J Cardiothorac Surg 2023; 63:7103312. [PMID: 37014372 DOI: 10.1093/ejcts/ezad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023] Open
Affiliation(s)
- María Ascaso
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
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22
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Ardini TW, Zebua JI, Ilyas KK, Nasution AN. Real-Time Three-Dimensional Transthoracic Echocardiography as a Decision-Making Tool for the Management of Postmyocardial Infarction Ventricular Septal Rupture: Guiding the Percutaneous Transcatheter Closure. J Cardiovasc Echogr 2023; 33:88-91. [PMID: 37772045 PMCID: PMC10529285 DOI: 10.4103/jcecho.jcecho_71_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/18/2023] [Accepted: 03/20/2023] [Indexed: 09/30/2023] Open
Abstract
Postmyocardial infarction ventricular septal rupture (PI-VSR) is a rare but lethal complication of acute myocardial infarction (AMI). The diagnosis and management of AMI remain challenging. When VSR is suspected, transthoracic and/or transesophageal echocardiography at patient's bedside is a test of choice for early diagnosis and therapeutical guidance. We aim to discuss the management of patients with VSR due to AMI with the focus on transcatheter closure management guided by real-time three-dimensional (RT3D) transthoracic echocardiography (TTE). A 64-year-old male patient was diagnosed with recent anterolateral ST elevation myocardial infarction and complication intra VSR as its complication. After remeasurement of the defect by TTE, we found an 8-11 mm defect in VSR. We performed transcatheter closure for VSR guided by RT3D TTE using Septal Occluder device No. 14. Evaluation after the procedure by TTE revealed that the device was well-seated. Percutaneous closure of PI-VSR may be considered in hemodynamically unstable patients if the risk of surgery is deemed to be too high or the anatomy is amenable to device insertion. RT3D echocardiography allows better delineation of the size and shape of the rupture, while serves as a guide during percutaneous transcatheter PI-VSR closure.
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Affiliation(s)
- Tengku Winda Ardini
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sumatera Utara University, General Hospital of Haji Adam Malik, Medan, Indonesia
| | - Juang Idaman Zebua
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sumatera Utara University, General Hospital of Haji Adam Malik, Medan, Indonesia
| | - Kamal Kharrazi Ilyas
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sumatera Utara University, General Hospital of Haji Adam Malik, Medan, Indonesia
| | - Ali Nafiah Nasution
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sumatera Utara University, General Hospital of Haji Adam Malik, Medan, Indonesia
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23
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Thapa L, Lemons L. Report on Rare Complication Post Silent Myocardial Infarction: Ventricular Septal Rupture. Cureus 2023; 15:e37389. [PMID: 37182041 PMCID: PMC10171707 DOI: 10.7759/cureus.37389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
The advent of primary reperfusion therapy for the treatment of myocardial infarction (MI) has made mechanical complications rare. Mechanical complications include free wall rupture, papillary muscle rupture, left ventricular septal rupture, and more. In this case, we describe a 53-year-old patient who presented to the emergency department with complaints of shortness of breath, abdominal pain, urinary retention, and constipation. On exam, he was in mild distress and presented with jugular venous distension (JVD), bibasilar crackles, and diffuse abdominal pain with guarding. After a rapid hemodynamic decline and a transthoracic echocardiogram that displayed a new onset ventricular septal defect (VSD), it was determined that the patient had a ventricular septal rupture (VSR). Septal rupture is a cardiac emergency causing cardiogenic shock and carries a high mortality risk despite prompt surgical treatment; hence a high suspicion is warranted. Our patient presented with generalized symptoms, no previous cardiovascular history, and no reported myocardial infarctions or risk factors, leading to a low clinical index of suspicion for a VSR. This case highlights the importance of high clinical suspicion of ventricular septal rupture in a patient presenting with similar symptoms so prompt management can occur.
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Affiliation(s)
- Luna Thapa
- Emergency Department, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - Lucas Lemons
- Emergency Medicine, King's Daughters Hospital, Ashland, USA
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24
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Lal Vallath A, Sivasubramanian BP, Chatterjee A, Erva S, Ravikumar DB, Dasgupta I. Ventricular Septal Rupture and Artificial Intelligence (AI)-Assisted Healthcare. Cureus 2023; 15:e36581. [PMID: 37095800 PMCID: PMC10122442 DOI: 10.7759/cureus.36581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
This case report highlights the use of point-of-care ultrasound (POCUS) for the diagnosis of ventricular septal rupture (VSR), a severe consequence of acute myocardial infarction (AMI). VSR has a broad spectrum of signs and inconspicuous symptoms, making the diagnosis difficult. POCUS offers non-invasive, real-time cardiac imaging and has an advantage over other methods due to its ability to identify VSR early. Here we present a 63-year-old female with a history of type 2 diabetes, hypothyroidism, hyperlipidemia, and a family history of cardiovascular disease, who came to the ED with chest pain for three days, palpitations, and dyspnea at rest. On examination, the patient was hypotensive, tachycardic, and had crackles with a harsh holosystolic murmur. An EKG and elevated troponin levels suggested acute on chronic anterior-lateral wall ST-elevation myocardial infarction (STEMI). Resuscitation efforts were initiated, followed by a lung ultrasound that revealed good lung sliding and multiple B lines without pleural thickening, indicating pulmonary edema. Echocardiography revealed ischemic heart disease with moderate left ventricle (LV) systolic dysfunction and a 14 mm apical ventricular septal rupture (hypokinetic thinning of the anterior wall, septum, apex, and anterolateral wall with a left ventricular ejection fraction (LVEF) of 39%). The presence of flow on color Doppler across the interventricular septum, showing left-to-right shunting, led to a definitive diagnosis of acute-on-chronic myocardial infarction (MI) with ventricular septal rupture. The case report also emphasizes how modern AI applications like ChatGPT (OpenAI, San Francisco, California, United States), aid in language and research, saving time and redefining the healthcare and research industry. As a result, we are confident that AI-assisted healthcare will be the next global breakthrough.
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Affiliation(s)
- Aditya Lal Vallath
- Emergency Medicine, Peerless Hospital and B. K. Roy Research Centre, Kolkata, IND
| | - Barath Prashanth Sivasubramanian
- Internal Medicine, Employees State Insurance Corporation Medical College & Employees State Insurance Post Graduate Institute of Medical Sciences and Research (ESIC MC & PGIMSR), Chennai, IND
| | - Aryapriyo Chatterjee
- Emergency Medicine, Peerless Hospital and B. K. Roy Research Centre, Kolkata, IND
| | - Snigdha Erva
- Internal Medicine, MNR (M. N. Raju) Medical College and Hospital, Fasalwadi, IND
| | - Diviya Bharathi Ravikumar
- Internal Medicine, Employees State Insurance Corporation Medical College & Employees State Insurance Post Graduate Institute of Medical Sciences and Research (ESIC MC & PGIMSR), Chennai, IND
| | - Indraneel Dasgupta
- Emergency Medicine, Peerless Hospital and B. K. Roy Research Centre, Kolkata, IND
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25
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Zhu Y, Luo S, Zeng C, Huang B. Ventricular septal rupture after acute myocardial infarction in a patient with venous thromboembolism complicated by thrombocytopenia: A case report. Clin Case Rep 2023; 11:e7059. [PMID: 36911635 PMCID: PMC9994429 DOI: 10.1002/ccr3.7059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
A woman that suffered burns previously presented with leg swelling and was diagnosed with venous thromboembolism. Heparin was given until she suddenly developed myocardial infarction. Ventricular septal rupture was detected and managed by transcatheter closure. She developed massive bleeding and extensive thrombosis that made treatment paradoxical and eventually died.
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Affiliation(s)
- Yuansong Zhu
- Department of Cardiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Suxin Luo
- Department of Cardiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Chun Zeng
- Department of Radiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Bi Huang
- Department of Cardiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
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26
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Kirbos C, Pagenhardt J, Minardi J, End B. Point-of-Care Ultrasound Diagnosis of Ventricular Septal Rupture Post Myocardial Infarction: A Case Report. J Emerg Med 2022; 63:777-780. [PMID: 36369118 DOI: 10.1016/j.jemermed.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/16/2022] [Accepted: 09/04/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ventricular septal rupture (VSR) is a rare but life-threatening complication of ST-elevation myocardial infarction. Point-of-care ultrasound (POCUS) is a rapid, noninvasive imaging modality that is easily accessible and highly effective in diagnosing VSR in the emergency department (ED) setting. CASE REPORT A 73-year-old man with a history of type II diabetes mellitus and hypertension presented with complaints of intermittent chest pain for 48 h that had since become constant, associated with diaphoresis and shortness of breath. Physical examination was notable for shock and a new, grade V/VI systolic murmur. An electrocardiogram showed evidence of an inferior ST-elevation myocardial infarction (MI) with associated Q waves. POCUS revealed a large ventricular septal rupture with new ventricular septal defect and associated left-to-right shunting. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS in the ED setting is an effective and rapid tool for elucidating the etiology of various shock states. Emergency physicians should be aware of this particular case, as POCUS may help identify MI-related complications, including post-myocardial infarction VSR, that may necessitate surgical intervention as opposed to coronary reperfusion procedures.
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Affiliation(s)
- Catherine Kirbos
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia
| | - Justine Pagenhardt
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia
| | - Joseph Minardi
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia; Department of Medical Education, West Virginia University, Morgantown, West Virginia
| | - Bradley End
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia; Department of Medical Education, West Virginia University, Morgantown, West Virginia
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Muacevic A, Adler JR. Ventricular Septal Rupture Following Acute Myocardial Infarction. Cureus 2022; 14:e29848. [PMID: 36348910 PMCID: PMC9630050 DOI: 10.7759/cureus.29848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022] Open
Abstract
ST-segment elevation myocardial infarction (STEMI) is a known medical exigency that has seen considerable advances in medical treatment, dramatically boosting survival rates. Post myocardial infarction ventricular rupture is a major serious mechanical complication following myocardial infarction. We present a case of a 68-year-old male admitted to the emergency department with heaviness in the chest, for which electrocardiography was done and it was suggestive of anterior and lateral wall myocardial infarction. After six hours he experienced breathlessness, jugular venous pressure (JVP) was raised, and auscultation revealed early systolic murmur at apex suggestive of ventricular septal rupture. An urgent echocardiogram was done and it confirmed the diagnosis of ventricular septal rupture (VSR). To enhance the prognosis, early identification and appropriate care are required, which necessitate a thorough clinical evaluation that raises the possibility of mechanical problem, as late presentation is one of the major risk factors for developing VSR. VSR can manifest itself in numerous ways, based on the patient's condition. Right clinical judgement and ECG are required to establish a quick diagnosis, as a result, to determine the most appropriate treatment at the appropriate time.
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Żbikowska K, Wróbel K. Mechanical Circulatory Support in Delayed Surgery of Post-Infarction Ventricular Septal Rupture in Patients in Cardiogenic Shock-A Review. J Clin Med 2022; 11:4728. [PMID: 36012967 DOI: 10.3390/jcm11164728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Post-infarction ventricular septal rupture (VSR) is a serious complication of myocardial infarction, which, in its natural course or treated medically, is related to high mortality rate. Surgical intervention remains the treatment of choice. Recent studies have shown that delayed surgery is related to better outcomes in comparison with urgent surgery; however, in many studies the impact of the patients' initial hemodynamic status on the treatment outcomes often remains unclear. In this review, we analyze the outcomes of delayed surgical treatment of patients in cardiogenic shock in the course of post-infarction ventricular septal defect stabilized with preoperative use of mechanical circulatory support. We evaluate the importance of various types of mechanical circulatory devices (MCD), such as extracorporeal membrane oxygenation, Tandem Heart, Impella, and intra-aortic baloon pump (IABP) in preoperative stabilization of patients, and the most suitable time for surgery, and we also present the features of ideal MCD for patients with VSR. A search of Pubmed to identify studies concerning the use of MCD in patients in cardiogenic shock in the course of VSR qualified for delayed surgery was conducted in January 2022. A total of 16 articles with three or more patients described were analyzed in this study. The preoperative use of MCD in patients in cardiogenic shock and delayed surgery as a main part of treatment seems to be a promising direction, however, it requires further research.
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Ronco D, Matteucci M, Massimi G, Lorusso R. Concomitant surgical revascularization in postinfarction ventricular septal rupture and ventricular aneurysm repair: A straightforward indication or a prognostic factor? J Card Surg 2022; 37:2703-2705. [PMID: 35703120 PMCID: PMC9543386 DOI: 10.1111/jocs.16673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Daniele Ronco
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiac Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Sánchez Vega JD, Alonso Salinas GL, Viéitez Florez JM, Ariza Solé A, López de Sá E, Sanz-Ruiz R, Burgos Palacios V, Raposeiras Roubin S, Gómez Varela S, Sanchís Forés J, Silva Melchor L, Martínez-Seara X, Malagón López L, Viana Tejedor A, Corbí Pascual M, Zamorano Gómez JL, Sanmartín-Fernández M. Optimal surgical timing after post-infarction ventricular septal rupture. Cardiol J 2022; 29:773-781. [PMID: 35578757 PMCID: PMC9550323 DOI: 10.5603/cj.a2022.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a dangerous condition. Surgical VSR closure is the definitive therapy, but there is controversy regarding the surgical timing and the bridging therapy between diagnosis and intervention. The objective of this study is to analyze the ideal time of surgical repair and to establish the contribution of mechanical circulatory support (MCS) devices on the prognosis. Methods We designed an observational, retrospective, multicenter study, selecting all consecutive patients with post-AMI VSR between January 1, 2008 and December 31, 2018, with non-exclusion criteria. The main objective of this study was to analyze the optimal timing for surgical repair of post-AMI VSR. Secondary endpoints were to determine which factors could influence mortality in the patients of the surgical group. Results A total of 141 patients were included. We identified lower mortality rates with an odds ratio of 0.3 (0.1–0.9) in patients operated on from day 4 compared with the surgical mortality in the first 24 hours after VSR diagnosis. The use of MCS was more frequent in patients treated with surgery, particularly for intra-aortic balloon pump (IABP; 79.6% vs. 37.8%, p < 0.001), but also for veno-arterial extracorporeal membrane oxygenation (VA-ECMO; 18.2% vs. 6.4%, p = 0.134). Total mortality was 91.5% for conservative management and 52.3% with surgical repair (p < 0.001). Conclusions In our study, we observed that the lowest mortality rates in patients with surgical repair of post-AMI VSR were observed in patients operated on from day 4 after diagnosis of VSR, compared to earlier interventions.
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Affiliation(s)
- Juan Diego Sánchez Vega
- Department of Cardiology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERCV, Madrid, Spain
| | - Gonzalo Luis Alonso Salinas
- Department of Cardiology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERCV, Madrid, Spain.,Department of Cardiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - José María Viéitez Florez
- Department of Cardiology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERCV, Madrid, Spain.,Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Albert Ariza Solé
- Department of Cardiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Esteban López de Sá
- Department of Cardiology, Hospital Universitario La Paz, IDIPAZ, Madrid, Spain.,Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain, Spain
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Susana Gómez Varela
- Department of Cardiology, Hospital Universitario de Cruces, Baracaldo, Sapin
| | - Juan Sanchís Forés
- Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Lorenzo Silva Melchor
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Xurxo Martínez-Seara
- Department of Cardiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Ana Viana Tejedor
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Clínico San Carlos, Madrid, Spain
| | - Miguel Corbí Pascual
- Department of Cardiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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Bachini JP, Torrado J, Vignolo G, Durán A, Biondi-Zoccai G. Postinfarction Ventricular Septal Rupture: Identification of the Failure Mechanism of a Percutaneous Closure Procedure. JACC Case Rep 2022; 4:255-61. [PMID: 35257098 DOI: 10.1016/j.jaccas.2021.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 02/08/2023]
Abstract
Ventricular septal rupture (VSR) is a rare but highly lethal (∼60%) mechanical complication of myocardial infarction (MI). Although surgical repair has been the gold standard to correct the structural anomaly, percutaneous closure of the defect may represent a valuable therapeutic alternative, with the advantage of immediate shunt reduction to prevent further hemodynamic deterioration in patients with prohibitive surgical risk. Nonetheless, catheter-based VSR closure has faced certain drawbacks that have hampered its application. We describe a clinical case of postinfarction VSR treated with a percutaneous closure device and discuss the procedure's failure mechanism. (Level of Difficulty: Intermediate.).
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Key Words
- ASD, atrial septal defect
- CMR, cardiac magnetic resonance
- CT, computed tomography
- IABP, intra-aortic balloon pump
- LAD, left anterior descending
- MI, myocardial infarction
- PCI, percutaneous coronary intervention
- STEMI, ST-segment myocardial infarction
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- VSD, ventricular septal defect
- VSR, ventricular septal rupture
- acute myocardial infarction
- mechanical complication
- percutaneous closure device
- percutaneous septal defect closure
- ventricular septal defect
- ventricular septal rupture
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32
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Telmesani A, Al Abri Q, Chamsi-Pasha M. Ventricular Septal Rupture Complicating Silent Myocardial Infarction. Methodist Debakey Cardiovasc J 2022; 18:77-80. [PMID: 36561080 PMCID: PMC9733161 DOI: 10.14797/mdcvj.1168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 12/12/2022] Open
Abstract
A 55-year-old gentleman presented to the emergency department with shortness of breath for the past 3 days. Cardiac magnetic resonance imaging assessed intracardiac shunting and a mechanism of ventricular septal rupture (VSR), showing significant left-to-right shunting and Qp:Qs of 4:1. There was transmural myocardial infarction as well as an aneurysm at the diaphragmatic inferior wall of the left ventricle.
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Affiliation(s)
- Amr Telmesani
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US,Department of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Qasim Al Abri
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Mohammed Chamsi-Pasha
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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33
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Nguyen RT, Satish P, Atkins MD, Goel SS. An Undiagnosed Ventricular Septal Rupture Presenting as New Onset Heart Failure: A Rare Complication of an Anterior Myocardial Infarction. Methodist Debakey Cardiovasc J 2022; 18:113-116. [PMID: 36561850 PMCID: PMC9733135 DOI: 10.14797/mdcvj.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Ventricular septal ruptures (VSR) are a rare but fatal complication of acute myocardial infarctions. We present a patient complaining of new onset heart failure symptoms that were found to be secondary to a new ventricular septal rupture from a recently undiagnosed anterior myocardial infarction. The patient underwent successful VSR patch repair with eventual recovery. This case highlights the importance of early diagnosis of VSR and reviews management options and appropriate timing for intervention.
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34
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Zalewski J, Nowak K, Furczynska P, Zalewska M. Complicating Acute Myocardial Infarction. Current Status and Unresolved Targets for Subsequent Research. J Clin Med 2021; 10:5904. [PMID: 34945202 DOI: 10.3390/jcm10245904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Mechanical reperfusion with primary angioplasty, as the treatment of choice in acute myocardial infarction (MI), is associated not only with a high percentage of full epicardial and tissue reperfusion but also with a very good immediate and long-term clinical outcome. However, the Achilles heel of MI treatment is its ensemble of complications, such as cardiogenic shock due to severe systolic and/or diastolic dysfunction or MI mechanical complications, including perforation of the left ventricular free wall, papillary muscle rupture with acute mitral regurgitation and ventricular septal rupture. They are associated with an increased or, sometimes, with an extremely high mortality rate, determining the overall mortality in an MI patient population. In this review we summarize the mechanisms of MI complications, current therapeutic management and alternative directions for overcoming their devastating consequences. Moreover, we have sought to indicate gaps in the evidence on current treatments as the potential targets for further clinical research. From the perspective of mortality trends that are not improving, the forthcoming therapeutic management of complicated MI will require an individualized and novel approach based on their thorough pathobiology.
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35
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Pradeep D. Insight into surgical outcomes of post-infarct-ventricular septal defect repair through a 23-year retrospective study-Invited commentary. J Card Surg 2021; 37:853-854. [PMID: 34910329 DOI: 10.1111/jocs.16182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022]
Abstract
The authors present an excellent retrograde analysis of a rare condition of a phenomenal number of cases and their surgical outcomes. A majority of the studies in published literature are anecdotal case reports which are a rare and dreadful entity. A comprehensive countrywide view of the UK National Adult Cardiac Surgery Audit database is presented in this study. This study represents the changing trends in the risk factors, management strategies, and outcomes of ventricular septal rupture for over 23 years in a nutshell.
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Affiliation(s)
- Doniparthi Pradeep
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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36
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Ng P, Sankhesara D, Weinert C, Alcock R, Andrews D, Best M, Joshi P, Rajwani A, Hillis G. Isolated Ventricular Septal Rupture in a Suicide Jumper. JACC Case Rep 2021; 3:1531-4. [PMID: 34693354 DOI: 10.1016/j.jaccas.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/30/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022]
Abstract
Ventricular septal rupture is an extremely rare sequelae of blunt chest trauma, and is mostly diagnosed postmortem. We present a case of a large isolated traumatic ventricular septal rupture after a suicide attempt by jumping from a height of 5 stories, which was successfully treated with surgical closure. (Level of Difficulty: Intermediate.)
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37
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Ahmed AS, Rai N, Divani G. Acute Dyspnea After Inferior-Wall Myocardial Infarction. J Invasive Cardiol 2021; 33:E834. [PMID: 34609329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 57-year-old woman presented with acute-onset dyspea with a duration of more than 2 days. Four days earlier, she had been thrombolyzed with streptokinase for inferior wall myocardial infarction in a nearby hospital. On examination, we found that the patient had elevated jugular venous pressure and systolic murmur in left lower parasternal region. In addition, there was a ventricular septal rupture in the posterobasal interventricular septum, with at least 2 exit points into the right ventricle. Timely identification of ventricular septal rupture before PCI is of paramount importance, as it has major implications in management of the patient.
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Affiliation(s)
- A Shaheer Ahmed
- Department of Cardiology, 7th floor, Super Speciality Block, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
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38
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Davarpasand T, Mohseni‐Badalabadi R, Sadeghian M, Mortazavi SH, Lalvand A. Concomitant ventricular septal rupture and interventricular septal aneurysm in neglected inferior myocardial infarction misdiagnosed with congenital ventricular septal defect: A case report. Clin Case Rep 2021; 9:e04959. [PMID: 34703603 PMCID: PMC8521315 DOI: 10.1002/ccr3.4959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 11/09/2022] Open
Abstract
This study emphasizes that VSD should not be immediately diagnosed as a congenital disorder; instead, regional wall motion abnormalities in the left ventricle should also be taken into account since it may result from mechanical complications of neglected myocardial infarction.
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Affiliation(s)
| | | | | | | | - Atefeh Lalvand
- Tehran Heart CenterTehran University of Medical SciencesTehranIran
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39
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Khandaker MAH, Panduranga P. Not all Postmyocardial Infarction Ventricular Septal Rupture Need Immediate Surgery: Role of Cardiogenic Shock Classification. Heart Views 2021; 22:141-145. [PMID: 34584627 PMCID: PMC8445139 DOI: 10.4103/heartviews.heartviews_138_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/31/2021] [Indexed: 11/04/2022] Open
Abstract
A 56-year-old man presented with acute anterior ST elevation myocardial infarction. Initially he was thrombolysed at a peripheral hospital and a transthoracic echocardiography revealed multiple (2-3 mm) apical muscular ventricular septal defects suggesting ventricular septal rupture (VSR), with the largest measuring 10mm with left to right shunt and max gradient was 74 mmHg. His left ventricular ejection fraction was 45%. A coronary angiogram revealed tight proximal (95%) and mid segments (80%) stenosis in the left anterior descending artery (LAD) but diffusely diseased distally. Another significant stenosis (80%) was present at the ostium of the right posterior descending artery (r-PDA). He was in Society for Cardiovascular Angiography and Intervention (SCAI) cardiogenic shock Stage B, hence cardiac surgeons advised conservative medical treatment in order to stabilize the infarct area with view of good surgical outcome. Although, there was a dilemma between the surgeon and the cardiologist regarding timing VSR closure, classification of shock stages helped to delay surgery. Eventually, he was taken for surgery at the 18th day of admission with a graft to r-PDA rather to LAD (due to difficult visualization) and repair of VSR with Gortex patch. In conclusion, in all patients with post MI VSR, SCAI shock stages classification has to be applied in determining the timing of surgery.
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Affiliation(s)
| | - Prashanth Panduranga
- Department of Cardiology, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
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40
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Gattani R, Bakhshi H, Ofosu-Somuah A, Qian X, Atkins M. Multimodality Imaging Assessment of Ventricular Septal Rupture and Intramyocardial Dissecting Hematoma Post Late-Presenting Acute Myocardial Infarction. Circ Cardiovasc Imaging 2021; 14:e013185. [PMID: 34579549 DOI: 10.1161/circimaging.121.013185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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41
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Pidello S, Simonato E, Orzan F, Frea S, Barreca A, Rinaldi M, Boffini M. Inter ventricular Septal Rupture in a 62-Year-Old Man With Familial Amyloid Polyneuropathy. Tex Heart Inst J 2021; 47:302-305. [PMID: 33472226 DOI: 10.14503/thij-18-6799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cardiac involvement in familial amyloid polyneuropathy consists of arrhythmias, conduction disturbances, and heart failure. To our knowledge, heart rupture has never been described in association with this condition. We report the case of a 62-year-old man with a 6-year history of refractory familial amyloid polyneuropathy who underwent liver transplantation. The operation was complicated by severe hypotension because the neuropathy involved the autonomic system. Perioperatively, the patient had a myocardial infarction, and during the next 10 days, a complete interventricular septal rupture developed, resulting in a systemic-to-pulmonary shunt. Coronary angiographic findings were normal. However, the shunt caused unstable hemodynamics, resulting in cardiogenic shock. An attempt to close the rupture percutaneously failed. The patient underwent successful heart transplantation 50 days later. Macroscopic examination of the explanted heart showed thickening of both ventricles, septal rupture, and a gray scar in the interventricular septum around the cavity. Histopathologic examination revealed intramural amyloid angiopathy. Our case shows that heart rupture can occur in patients with familial amyloid polyneuropathy who have no history of obstructive coronary artery disease, perhaps as a result of tissue fragility caused by amyloid angiopathy. Therefore, autonomic disturbances should be regarded with concern and promptly treated in the perioperative period.
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Affiliation(s)
- Stefano Pidello
- Division of Cardiology, Città della Salute e della Scienza, University Hospital of Torino, 10126 Torino, Italy
| | - Erika Simonato
- Division of Cardiac Surgery, Città della Salute e della Scienza, University Hospital of Torino, 10126 Torino, Italy
| | - Fulvio Orzan
- Division of Cardiology, Città della Salute e della Scienza, University Hospital of Torino, 10126 Torino, Italy
| | - Simone Frea
- Division of Cardiology, Città della Salute e della Scienza, University Hospital of Torino, 10126 Torino, Italy
| | - Antonella Barreca
- Division of Pathology, Città della Salute e della Scienza, University Hospital of Torino, 10126 Torino, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Città della Salute e della Scienza, University Hospital of Torino, 10126 Torino, Italy
| | - Massimo Boffini
- Division of Cardiac Surgery, Città della Salute e della Scienza, University Hospital of Torino, 10126 Torino, Italy
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Khorolsky C, Pettijohn D, Yager N. Post-Infarction Ventricular Septal Rupture Complicated by Cardiogenic Shock Requiring Mechanical Circulatory Support as a Bridge to Definitive Therapy During the COVID-19 Pandemic. Cureus 2021; 13:e16421. [PMID: 34422462 PMCID: PMC8369983 DOI: 10.7759/cureus.16421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/05/2022] Open
Abstract
Ventricular septal rupture (VSR) is a devastating complication of acute myocardial infarction (MI) and is often associated with cardiogenic shock. Although considered to be very rare in the reperfusion era, recent reports have demonstrated an increased frequency of post-MI VSR cases during the COVID-19 pandemic. Despite advances in surgical repair and management strategies over the past decades, mortality rate has remained high, especially in hemodynamically unstable patients. In VSR patients with cardiogenic shock, the use of mechanical circulatory support (MCS) could be used as a bridge to surgical intervention. We report a patient with VSR complicated by cardiogenic shock secondary to late presenting MI, managed successfully with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to surgical intervention.
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Affiliation(s)
| | | | - Neil Yager
- Cardiology, Albany Medical College, Albany, USA
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43
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Nguyen HL, Palaskas N, Lakkis N, Tabbaa R. Rare silent ischemic ventricular septal aneurysm and rupture: A multimodality diagnostic approach. Clin Case Rep 2021; 9:e04284. [PMID: 34429974 PMCID: PMC8365393 DOI: 10.1002/ccr3.4284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/15/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022] Open
Abstract
A multimodality approach in addition to high level of clinical suspicion and thorough physical examination is important in the diagnosis and management of left ventricular aneurysm and rupture after a silent inferior infarction.
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Kowatari R, Kondo N, Watanabe S, Daitoku K, Minakawa M. Urgent repair of postinfarct ventricular septal rupture with ECPELLA support: A case report. J Card Surg 2021; 36:3933-3935. [PMID: 34291837 DOI: 10.1111/jocs.15834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/03/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
A 74-year-old woman developed inferior myocardial infarction due to right coronary artery occlusion and underwent percutaneous coronary intervention. Two days later, echocardiography revealed ventricular septal rupture, and Impella CP was inserted to avoid emergency surgery. However, the patient's hemodynamics deteriorated rapidly, necessitating additional venoarterial extracorporeal membranous oxygenation support with concomitant Impella support (ECPELLA). The ventricular septal rupture was surgically repaired using the extended sandwich technique via a right ventricular approach; the ascending aorta was clamped with the clampable portion of the Impella. The patient was successfully weaned from the Impella 3 days postsurgery. This case suggests that urgent surgery with ECPELLA support could be a useful option for patients with ventricular septal rupture, even in severe cases wherein emergency surgery is unavoidable.
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Affiliation(s)
- Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Norihiro Kondo
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Shuto Watanabe
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
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Ronco D, Matteucci M, Ravaux JM, Marra S, Torchio F, Corazzari C, Massimi G, Beghi C, Maessen J, Lorusso R. Mechanical Circulatory Support as a Bridge to Definitive Treatment in Post-Infarction Ventricular Septal Rupture. JACC Cardiovasc Interv 2021; 14:1053-1066. [PMID: 34016403 DOI: 10.1016/j.jcin.2021.02.046] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 01/30/2023]
Abstract
Ventricular septal rupture (VSR) represents a rare complication of acute myocardial infarction, often presenting with cardiogenic shock and associated with high in-hospital mortality despite prompt intervention. Although immediate surgery is recommended for patients who cannot be effectively stabilized, the ideal timing of intervention remains controversial. Mechanical circulatory support (MCS) may allow hemodynamic stabilization and delay definitive treatment even in critical patients. However, the interactions between MCS and VSR pathophysiology as well as potentially related adverse effects remain unclear. A systematic review was performed, from 2000 onward, to identify reports describing MCS types, effects, complications, and outcomes in the pre-operative VSR-related setting. One hundred eleven studies (2,440 patients) were included. Most patients had well-known negative predictors (e.g., cardiogenic shock, inferior infarction). Almost all patients had intra-aortic balloon pumps, with additional MCS adopted in 129 patients (77.5% being venoarterial extracorporeal membrane oxygenation). Mean MCS bridging time was 6 days (range: 0 to 23 days). In-hospital mortality was 50.4%, with the lowest mortality rate in the extracorporeal membrane oxygenation group (29.2%). MCS may enhance hemodynamic stabilization and delayed VSR treatment. However, the actual effects and interaction of the MCS-VSR association should be carefully assessed to avoid further complications or incorrect MCS-VSR coupling.
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Affiliation(s)
- Daniele Ronco
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy.
| | - Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Justine M Ravaux
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Silvia Marra
- Humanitas Clinical and Research Center-IRCCS, Scientific Documentation Center, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Federica Torchio
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Claudio Corazzari
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Cesare Beghi
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Jos Maessen
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
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Arias EA, Sandoval JP, Farjat-Pasos JI, Rodríguez-Zanella H, Mora-Cervantes RDL. Novel Cinematic Rendering Use for Ventricular Septal Ruptures: "The Good, the Bad, and the Ugly". JACC Cardiovasc Interv 2021; 14:1151-1153. [PMID: 33933385 DOI: 10.1016/j.jcin.2021.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Eduardo A Arias
- Structural Heart Intervention, Interventional Cardiology Department, "Ignacio Chávez" National Institute of Cardiology, Mexico City, Mexico.
| | - Juan Pablo Sandoval
- Structural Heart Intervention, Interventional Cardiology Department, "Ignacio Chávez" National Institute of Cardiology, Mexico City, Mexico
| | - Julio I Farjat-Pasos
- Structural Heart Intervention, Interventional Cardiology Department, "Ignacio Chávez" National Institute of Cardiology, Mexico City, Mexico
| | - Hugo Rodríguez-Zanella
- Echocardiography Department, "Ignacio Chávez" National Institute of Cardiology, Mexico City, Mexico
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Dallan LRP, Dallan LAO, Lisboa LAF, Mejia OAV, Veronese ET, Camilo JPM, Nascimento PCM, Jatene FB. Increased number of ventricular septal rupture cases after acute myocardial infarction in 2020. J Card Surg 2021; 36:2253-2262. [PMID: 33834536 DOI: 10.1111/jocs.15526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Ventricular septal rupture (VSR) is a serious mechanical complication after acute coronary syndrome and is related to high mortality. Even with advances in the management of acute myocardial infarction (AMI) such as reperfusion therapies, complication rates are still high. During quarantine, patients presenting mechanical complications after AMI have increased in our institution. METHODS From a retrospective database analysis in our institution between the years 2004 and 2020, we identified 37 cases of VSR after AMI. Four chronic cases were excluded from our analysis. The primary endpoint was to identify baseline characteristics that increased 30-day mortality. RESULTS Among 33 acute cases of VSR, 24 cases were submitted to surgery. The 30-day mortality of the operated patients was 45.8%. From 2004 to 2019 our average number of operations of VSR was 1.9 cases/year with an increase to 4 cases/year in 2020. Diabetes mellitus, age, cardiogenic shock, and use of intra-aortic balloon pump were associated with significantly increased mortality using logistic regression. CONCLUSION We reported an increased number of mechanical complication cases from April to September 2020, compared to our historical records. Despite therapeutic advances, mortality rates remain high. Although the number of cases is small to conclude that the pandemic was responsible for this augmentation, we believe that it is related to the decreased number of patients seeking medical assistance.
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Affiliation(s)
- Luis R P Dallan
- Cardiac Surgery Department, INCOR - Heart Institute, University of Sao Paulo, São Paulo, SP, Brazil
| | - Luis A O Dallan
- Cardiac Surgery Department, INCOR - Heart Institute, University of Sao Paulo, São Paulo, SP, Brazil
| | - Luiz A F Lisboa
- Cardiac Surgery Department, INCOR - Heart Institute, University of Sao Paulo, São Paulo, SP, Brazil
| | - Omar A V Mejia
- Cardiac Surgery Department, INCOR - Heart Institute, University of Sao Paulo, São Paulo, SP, Brazil
| | - Elinthon T Veronese
- Cardiac Surgery Department, INCOR - Heart Institute, University of Sao Paulo, São Paulo, SP, Brazil
| | - Juliana P M Camilo
- Cardiac Surgery Department, INCOR - Heart Institute, University of Sao Paulo, São Paulo, SP, Brazil
| | - Polyanna C M Nascimento
- Cardiac Surgery Department, INCOR - Heart Institute, University of Sao Paulo, São Paulo, SP, Brazil
| | - Fabio B Jatene
- Cardiac Surgery Department, INCOR - Heart Institute, University of Sao Paulo, São Paulo, SP, Brazil
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Alsaad AA, Russell HM, Tokarczyk AJ, Ricciardi MJ. Hybrid approach to postmyocardial infarction ventricular septal defect repair. Catheter Cardiovasc Interv 2021; 97:E731-E735. [PMID: 32473072 DOI: 10.1002/ccd.29000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/01/2020] [Accepted: 05/12/2020] [Indexed: 11/07/2022]
Abstract
Postinfarction ventricular septal rupture is a rare and devastating complication of myocardial infarction. Despite attempts at acute surgical and percutaneous defect closure, morbidity and mortality remain high. Herein, we describe a hybrid surgical and catheter-based approach to defect closure in a 63-year-old woman with postinfarction ventricular septal rupture and cardiogenic shock.
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Affiliation(s)
- Ali A Alsaad
- Department of Medicine/Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Hyde M Russell
- Department of Cardiothoracic Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Arthur J Tokarczyk
- Department of Anesthesiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Mark J Ricciardi
- Department of Medicine/Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
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Goraya MHN, Kalsoom S, Almas T, Amin MK, Hussain N, Awan JR, Ehtesham M, Niaz MA, Virk HUH, Filby SJ. Simultaneous Left Ventricular Aneurysm and Ventricular Septal Rupture Complicating Delayed STEMI Presentation: A Case-Based Review of Post-MI Mechanical Complications Amid the COVID-19 Pandemic. J Investig Med High Impact Case Rep 2021; 9:23247096211031135. [PMID: 34259086 PMCID: PMC8283223 DOI: 10.1177/23247096211031135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
Amid the coronavirus disease 2019 (COVID-19) pandemic, there is an unprecedented increase in public avoidance of hospitals predominantly driven by fear of contracting the virus. Recent publications highlight a re-emergence of rare post-myocardial infarction complications. While mechanical complications are infrequent in the era of primary percutaneous coronary intervention, they are associated with high mortality rates. The concurrent occurrence of mechanical complications such as left ventricular aneurysm and ventricular septal rupture is an extremely rare entity. We hereby delineate a unique case of a 53-year-old Caucasian male who underwent successful concomitant closure of a ventricular septal rupture, left ventricular aneurysmectomy, and 3-vessel coronary artery bypass grafting. Due to a delayed initial presentation owing to the patient's fear of contracting COVID-19, the surgery was carried out 3 months after the myocardial infarction. His postoperative evaluation confirmed normal contractility of the left ventricle and complete closure of the ventricular septal rupture. Six months postoperatively, the patient continues to do well. We also present a literature review of the mechanical complications following delayed presentation of myocardial infarction amid the COVID-19 pandemic. This article illustrates that clinicians should remain cognizant of these extremely rare but potentially lethal collateral effects during the ongoing global public-health challenge. Furthermore, it highlights a significant concern regarding the delay in first medical contact due to the reluctance of patients to visit the hospital during the COVID-19 pandemic.
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Affiliation(s)
| | - Sidra Kalsoom
- Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | | | | | - Steven J. Filby
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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50
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Sanmartín-Fernández M, Raposeiras-Roubin S, Anguita-Sánchez M, Marín F, Garcia-Marquez M, Fernández-Pérez C, Bernal-Sobrino JL, Elola-Somoza FJ, Bueno H, Cequier Á. In-hospital outcomes of mechanical complications in acute myocardial infarction: Analysis from a nationwide Spanish database. Cardiol J 2020; 28:589-597. [PMID: 33346367 DOI: 10.5603/cj.a2020.0181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Mechanical complications represent an important cause of mortality in myocardial infarction (MI) patients. This is a nationwide study performed to evaluate possible changes in epidemiology or prognosis of these complications with current available strategies. METHODS Information was obtained from the minimum basis data set of the Spanish National Health System, including all hospitalizations for acute myocardial infarction (AMI) from 2010 to 2015. Risk-standardized in-hospital mortality ratio was calculated using multilevel risk adjustment models. RESULTS A total of 241,760 AMI episodes were analyzed, MI mechanical complications were observed in 842 patients: cardiac tamponade in 587, ventricular septal rupture in 126, and mitral regurgitation due to papillary muscle or chordae tendineae rupture in 155 (there was more than one complication in 21 patients). In-hospital mortality was 59.5%. On multivariate adjustment, variables with significant impact on in-hospital mortality were: age (OR 1.06; 95% CI 1.04-1.07; p < 0.001), ST-segment elevation AMI (OR 2.91; 95% CI 1.88-4.5; p < 0.001), cardiogenic shock (OR 2.35; 95% CI 1.66-3.32; p < 0.001), cardio-respiratory failure (OR 3.48; 95% CI 2.37-5.09; p < 0.001), and chronic obstructive pulmonary disease (OR 1.85; 95% CI 1.07-3.20; p < 0.001). No significant trends in risk-adjusted in-hospital mortality were detected (IRR 0.997; p = 0.109). Cardiac intensive care unit availability and more experience with mechanical complications management were associated with lower adjusted mortality rates (56.7 ± 5.8 vs. 60.1 ± 4.5; and 57 ± 6.1 vs. 59.9 ± 5.6, respectively; p < 0.001). CONCLUSIONS Mechanical complications occur in 3.5 per thousand AMI, with no significant trends to better survival over the past few years. Advanced age, cardiogenic shock and cardio-respiratory failure are the most important risk factors for in-hospital mortality. Higher experience and specialized cardiac intensive care units are associated with better outcomes.
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Affiliation(s)
| | | | | | - Francisco Marín
- Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, IMIB-Arrixaca, CIBERCV, Murcia, Spain
| | | | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.,Servicio de Medicina Preventiva, Complejo Hospitalario Universitario De Santiago de Compostela, Spain
| | - Jose-Luis Bernal-Sobrino
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.,Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Héctor Bueno
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ángel Cequier
- Hospital Universitario de Bellvitge, Universidad de Barcelona, IDIBELL, Hospitalet de Ll, Spain
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