Post-myocardial infarction ventricular septal defect: an angiographic study

Anterior Papillary Muscle Rupture due to Acute Myocardial Microinfarction of the Small High Lateral Branch

Papillary muscle rupture is a catastrophic condition, of which most cases manifest posterior papillary muscle rupture. Anterior papillary muscle rupture is a rare condition. Particularly, anterior papillary muscle rupture due to acute myocardial microinfarction of the small high lateral branch is extremely rare. Since papillary muscle rupture can occur even in such a small branch or small area due to myocardial infarction, echocardiographic and/or ventriculographic confirmation is essential in cases of sudden worsening of heart failure. Herein, we report the case of anterior papillary muscle rupture with a good outcome. A 61-year-old man was admitted to our hospital with cardiogenic shock. Echocardiography revealed severe mitral regurgitation due to papillary muscle rupture. Coronary angiography demonstrated high-grade stenosis in the high lateral branch. However, no other significant stenoses were found. Emergency mitral valve replacement was performed. The patient was discharged 19 days after surgery without any complications.

In-hospital outcome of patients with post-MI VSD: a single-center study

Introduction

Ventricular septal defect (VSD) is a rare but life-threatening complication of acute myocardial infarction (AMI). There is a paucity of data regarding the natural history of this devastating complication of myocardial infarction in the Middle East region with restricted financial resources and unsolved major health problems.

Aim

To evaluate the clinical presentation and in-hospital outcome of patients with post-infarction VSD over a 10-year period in a tertiary center in northwest Iran.

Material and methods

Data from 64 consecutive patients with VSD complicating AMI were retrospectively analyzed from March 2005 to May 2015.

Results

The mean age of the patients was 71.62 ±9.38 years with 57.8% of them being female. The VSDs were anterior in 52 (82%) patients. More than half of patients were in cardiogenic shock during the initial presentation. Multivessel coronary artery disease was found on coronary angiography in 70.3% of patients. In-hospital mortality was 82.8%. Multivariate analysis revealed cardiogenic shock (HR = 12.5, p = 0.001) as the only independent predictor of in-hospital mortality and surgical treatment as the only predictor of in-hospital survival (HR = 0.2, p = 0.02).

Conclusions

Our study demonstrated that VSD complicating myocardial infarction had an extremely high in-hospital mortality rate. Cardiogenic shock was the only independent predictor of in-hospital mortality and surgical treatment was the only predictor of in-hospital survival.

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

Objective:

The study aimed to identify the factors affecting the prognosis of post myocardial infarction (MI) ventricular septal rupture (VSR) and to develop a protocol for its management.

Methods:

This was a single center, retrospective-prospective study (2009-2014), involving 55 patients with post MI VSR. The strengths of association between risk factors and prognosis were assessed using multivariate logistic regression analysis. The UNM Post MI VSR management and prognosis scoring systems (UPMS & UPPS) were developed.

Results:

Thirty-day mortality was 52.5% (35% in the last 3 years). Twenty-eight (70%) patients underwent concomitant coronary artery bypass grafting. Residual ventricular septal defect was found in 3 (7.5%) patients. The multivariate analysis showed low mean blood pressure with intra-aortic balloon pump (OR 11.43, P=0.001), higher EuroSCORE II (OR 7.47, P=0.006), higher Killip class (OR 27.95, P=0.00), and shorter intervals between MI and VSR (OR 7.90, P=0.005) as well as VSR and Surgery (OR 5.76, P=0.016) to be strong predictors of mortality. Concomitant coronary artery bypass grafting (P=0.17) and location (P=0.25) of VSR did not affect the outcome. Mean follow-up was 635.8±472.5 days and 17 out of 19 discharged patients were in NYHA class I-II.

Conclusion:

The UNM Post-MI VSR Scoring Systems (UPMS & UPPS) help in management and prognosis, respectively. They divide patients into 3 groups: 1) Immediate Surgery - Patients with scores of <25 require immediate surgery, preferably with extracorporeal membrane oxygenation support, and have poor prognosis; 2) Those with scores of 25-75 should be managed with "Optimal Delay" and they have intermediate outcomes; 3) Patients with scores of >75 can undergo Elective Repair and they are likely to have good outcomes.