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Fiszer R, Galeczka M, Smolka G, Sukiennik A, Chojnicki M, Tyc F, Bialkowski J, Szkutnik M. Multicentre short- and medium-term report on the device closure of a post-myocardial infarction ventricular septal rupture - In search of risk factors for early mortality. Int J Cardiol 2024; 401:131820. [PMID: 38307419 DOI: 10.1016/j.ijcard.2024.131820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/14/2024] [Accepted: 01/28/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Post-myocardial infarction ventricular septal rupture (VSR) is a rare and severe complication of myocardial infarction. To find early mortality (<30 days) risk factors of device VSR closure and to evaluate its medium-term outcome. METHODS Multicenter retrospective analysis on all 46 consecutive patients with percutaneous (n = 43) or hybrid (n = 3) VSR closure in 2000-2020 with various nitinol wire mesh occluders. Medical records, hemodynamic data, procedure results, short- and mid-term follow-up were analyzed (4.8 ± 3.7 years, range: 0.1-15, available in 61.7% of patients). Of the patients, 34.8% underwent VSR closure in acute phase (<21 days after VSR occurrence), 17.4% underwent device closure due to significant residual shunt after previous VSR surgery. RESULTS Success rate was 78.3%. More than moderate residual shunt, major complications, and early surgical reintervention affected 18.9%, 15.2% (including 2 intra-procedural deaths), and 21.7% of patients, respectively. Early mortality was 26.1% (13.9% in successful vs. 70% in unsuccessful closure; p < 0.001). Older age, need for intra-aortic balloon counterpulsation, severe complications, and procedural failure were identified as risk factors for early mortality. Among patients who survived the early period, the 5-year survival rate was 57.1%. NYHA class improved in 88.2% patients at the latest follow-up. CONCLUSIONS Procedure of VSR device closure demonstrates an acceptable technical success rate; however, the incidence of severe complications and early mortality is notably high. Older patients in poor hemodynamic condition and those with unsuccessful occluder deployment are particularly at a higher risk of a fatal outcome. The prognosis after early survival is promising.
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Affiliation(s)
- Roland Fiszer
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Michal Galeczka
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, 3(rd) Division of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Adam Sukiennik
- Department of Cardiology and Internal Diseases, University Hospital No. 1, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Maciej Chojnicki
- Department of Cardiology and Internal Diseases, University Hospital No. 1, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Filip Tyc
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Jacek Bialkowski
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Malgorzata Szkutnik
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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2
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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] [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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Giblett JP, Matetic A, Jenkins D, Ng CY, Venuraju S, MacCarthy T, Vibhishanan J, O'Neill JP, Kirmani BH, Pullan DM, Stables RH, Andrews J, Buttinger N, Kim WC, Kanyal R, Butler MA, Butler R, George S, Khurana A, Crossland DS, Marczak J, Smith WHT, Thomson JDR, Bentham JR, Clapp BR, Buch M, Hayes N, Byrne J, MacCarthy P, Aggarwal SK, Shapiro LM, Turner MS, de Giovanni J, Northridge DB, Hildick-Smith D, Mamas MA, Calvert PA. Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry. Eur Heart J 2022; 43:5020-5032. [PMID: 36124729 DOI: 10.1093/eurheartj/ehac511] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/16/2022] [Accepted: 09/01/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Post-infarction ventricular septal defect (PIVSD) is a mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken. METHODS AND RESUTS Patients treated with surgical or percutaneous repair of PIVSD (2010-2021) were identified at 16 UK centres. Case note review was undertaken. The primary outcome was long-term mortality. Patient groups were allocated based upon initial management (percutaneous or surgical). Three-hundred sixty-two patients received 416 procedures (131 percutaneous, 231 surgery). 16.1% of percutaneous patients subsequently had surgery. 7.8% of surgical patients subsequently had percutaneous treatment. Times from AMI to treatment were similar [percutaneous 9 (6-14) vs. surgical 9 (4-22) days, P = 0.18]. Surgical patients were more likely to have cardiogenic shock (62.8% vs. 51.9%, P = 0.044). Percutaneous patients were substantially older [72 (64-77) vs. 67 (61-73) years, P < 0.001] and more likely to be discussed in a heart team setting. There was no difference in long-term mortality between patients (61.1% vs. 53.7%, P = 0.17). In-hospital mortality was lower in the surgical group (55.0% vs. 44.2%, P = 0.048) with no difference in mortality after hospital discharge (P = 0.65). Cardiogenic shock [adjusted hazard ratio (aHR) 1.97 (95% confidence interval 1.37-2.84), P < 0.001), percutaneous approach [aHR 1.44 (1.01-2.05), P = 0.042], and number of vessels with coronary artery disease [aHR 1.22 (1.01-1.47), P = 0.043] were independently associated with long-term mortality. CONCLUSION Surgical and percutaneous repair are viable options for management of PIVSD. There was no difference in post-discharge long-term mortality between patients, although in-hospital mortality was lower for surgery.
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Affiliation(s)
- Joel P Giblett
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Andrija Matetic
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, University Hospital of Split, Split, Croatia
| | - David Jenkins
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Choo Y Ng
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | | | - Tobias MacCarthy
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK.,University of Cambridge, Cambridge, UK
| | - Jonathan Vibhishanan
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK.,University of Cambridge, Cambridge, UK
| | | | - Bilal H Kirmani
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - D Mark Pullan
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Rod H Stables
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | | | | | | | - Robert Butler
- Royal Stoke University Hospital, Stoke-upon-Trent, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Suneil K Aggarwal
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | | | | | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.,University of Bristol, Bristol, UK
| | - Patrick A Calvert
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK.,University of Cambridge, Cambridge, UK
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4
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Flynn CD, Morris P, Manuel L, Matteucci M, Ronco D, Massimi G, Torchio F, Lorusso R. Systematic review and meta-analysis of the mechanical complications of ischemic heart disease: papillary muscle rupture, left ventricle rupture and post-infarct ventricular septal defect. Ann Cardiothorac Surg 2022; 11:195-209. [PMID: 35733707 PMCID: PMC9207690 DOI: 10.21037/acs-2022-ami-24] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/26/2022] [Indexed: 11/07/2023]
Abstract
BACKGROUND Improvements in revascularisation, including pharmacological, catheter-based and surgical, have resulted in improved outcomes for patients with acute myocardial infarction (AMI), leading to decreased frequency of mechanical complications. Improvements in both techniques and technology have permitted select patients to be managed with a purely percutaneous, transcatheter strategy. Through systematic review, this study aims to synthesise the collective experience of percutaneous treatment of the mechanical complications of ischaemic heart disease. METHODS The search strategy queried the electronic databases PubMed, Embase and the Cochrane Central Register of Controlled Trials, from 1 January 2000 to 31 December 2020. Studies highlighting the outcomes of patients receiving percutaneous treatment of post-myocardial infarction papillary muscle rupture (PMR), ventricular septal defect (VSD), left ventricular free wall rupture (FWR) and pseudoaneurysm (PA) were included. A qualitative review of studies was conducted for PMR, FWR and PA. A quantitative analysis was conducted for VSD. RESULTS Fifteen studies were included in the qualitative synthesis of the percutaneous management of PMR, 4 were included in the qualitative analysis of the percutaneous management of left ventricular FWR, 7 studies defined the outcomes of the percutaneous management of PA and 25 were included in the quantitative meta-analysis of the primary percutaneous management of post-MI VSD. For VSD, there were 43 failed procedures in 314 patients. The proportion of failed procedures was 15.9% and there were 174 deaths in 428 patients. 37.5% of patients experienced early mortality. CONCLUSIONS Although surgical techniques remain the gold standard, we have shown that percutaneous management may be a viable option in certain cases.
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Affiliation(s)
- Campbell D. Flynn
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
- North Shore Cardiothoracic Research Institute (NCRI), Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Paraskevi Morris
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lucy Manuel
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Matteo Matteucci
- Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Daniele Ronco
- Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulio Massimi
- Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Department of Cardiac Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Federica Torchio
- Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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5
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Percutaneous Closure of Post-infarction and Iatrogenic Ventricular Septal Ruptures Using Amplatzer Occluder®: A Systematic Review. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2021; 9:184-189. [PMID: 33681458 PMCID: PMC7932455 DOI: 10.12691/ajmcr-9-3-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Ventricular septal rupture (VSR) is a rare complication of myocardial infarction (MI), open heart surgery, and cardiac-based procedures, such as septal myectomy and valve replacement. VSR is associated with high mortality rates and the reported 30-day survival rate is less than 10% without any interventional therapy. Hence, prompt diagnosis and aggressive medical treatment with appropriate surgical intervention are necessary to improve survival. Immediate surgical intervention which is the standard treatment of VSR has a mortality rate of 19-60%. Due to persistent high mortality rate and challenging management of VSR, alternatives to surgical repair has been proposed; transcatheter approach as a new alternative method has been used for the closure of post-surgery residual defects or as a bridge to surgery and in some cases as a definitive therapy instead of surgical repair. Amplatzer Occluder® (AO), a type of transcatheter closure devices, is an approved method of repairing congenital atrial septal defects and it is being used as an alternative method of treatment in VSR. In this systemic review, we assessed the cases of VSR who underwent septal repair by using AO. The study shows that the total mortality rate of percutaneous VSR repair with AO is 20% which is comparable to 19-60% rate of death in patients who undergo surgery. While early intervention is necessary to prevent biventricular dysfunction, immediate surgical intervention on soft and friable tissue surrounding the infarction increases the risk of residual shunt and reoperation. However, this study reveals that the mortality rate of primary percutaneous VSR closure within 7 days of VSR detection was 37 % which is significantly lower than 60% in surgical repair in the same period. In conclusion, given that the prevalence of residual leak in both interventions are similar and close to 20%, percutaneous VSR closure with AO device could be superior to the surgical repair as a primary intervention in unstable or high-risk surgical patients.
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6
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Giblett JP, Jenkins DP, Calvert PA. Transcatheter treatment of postinfarct ventricular septal defects. Heart 2020; 106:878-884. [DOI: 10.1136/heartjnl-2019-315751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/03/2022] Open
Abstract
Postinfarct ventricular septal defects (VSDs) are a mechanical complication of acute myocardial infarction (AMI) with a very poor prognosis. They are estimated to occur in 0.2% of patients presenting with AMI, with 1-month survival of 6% without intervention. Guidelines recommend surgical repair, but recent advances in transcatheter technology, and bespoke device development, mean it is increasingly viable as a closure option. Surgical mortality is between 30% and 50% for all-comers, while in series of transcatheter closure, mortality was 32%. Transcatheter closure appears durable, with no evidence of late leaks and low long-term mortality in series with up to 5-year follow-up. Guidelines recommend early closure, which is likely to provide most benefit for patients regardless of the closure method. Multimodality cardiac imaging including echocardiography, CT and cardiac MRI can define size, shape, location of defects and their relationship to other cardiac structures, assisting with treatment decisions. Brief delay to allow stabilisation of the patient is appropriate, but untreated patients risk rapid deterioration. Mechanical circulatory support may be helpful, although the preferred modality is unclear. Transcatheter closure involves large bore venous access and the formation of an arteriovenous loop (under fluoroscopic and trans-oesophageal echocardiographic guidance) in order to facilitate deployment of the device in the defect and close the postinfarct VSD. Guidelines suggest transcatheter closure as an alternative to surgical repair in centres where appropriate expertise exists, but decisions for all patients with postinfarct VSD should be led by the multidisciplinary heart team.
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7
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Boi A, Cocco D, Sanna F, Rossi A, Fele GS, Tumbarello R, Manconi M, Lixi G, Cirio EM, Loi B. Post-Myocardial Infarction Ventricular Septal Defect Closure by a Percutaneous Septal Occluder Device After Unsuccessful Surgical Closure: Never Lose Hope. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:65-68. [PMID: 31427103 DOI: 10.1016/j.carrev.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/03/2019] [Indexed: 11/16/2022]
Abstract
Post myocardial infarction ventricular septal defect (VSD) is a life-threatening complication following ST elevation myocardial infarction (STEMI). Current guidelines recommend the urgent VSD closure for its significant mortality. Despite VSD is generally treated by surgical repair, surgeons often refrain from early surgery due to extremely poor results. We report the case of a 76-year-old women admitted to our hospital for a subacute myocardial infarction complicated by acute heart failure with VSD and apical thrombosis. The patient underwent an urgent surgical repair of VSD with a bovine pericardium patch and concomitant double saphenous vein graft for the left anterior descending and the first diagonal branch. After two days an early surgical patch dehiscence was observed and a percutaneous closure was planned. Due to the particular morphology of the unnatural anatomy of the septum generated by the dehiscence, we decided to close the defect using an off-label device for ventricular rupture. A 30/30 mm Amplatzer ASD-MF occluder was successfully implanted. At one-year follow up the patient was alive without significant residual shunt.
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Affiliation(s)
- Alberto Boi
- Interventional Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy.
| | - Daniele Cocco
- Interventional Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy
| | - Francesco Sanna
- Interventional Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy
| | - Angelica Rossi
- Interventional Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy
| | | | - Roberto Tumbarello
- Pediatric Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy
| | - Manlio Manconi
- Cardiac Anesthesia, Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy
| | - Giovanni Lixi
- Cardiac Surgery, Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy
| | | | - Bruno Loi
- Interventional Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy
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8
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Faccini A, Butera G. Techniques, Timing, and Prognosis of Transcatheter Post Myocardial Infarction Ventricular Septal Defect Repair. Curr Cardiol Rep 2019; 21:59. [DOI: 10.1007/s11886-019-1142-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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9
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Shahreyar M, Akinseye O, Nayyar M, Ashraf U, Ibebuogu UN. Post-Myocardial Infarction Ventricular Septal Defect: A Comprehensive Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 21:1444-1449. [PMID: 30527592 DOI: 10.1016/j.carrev.2018.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/22/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
Post-myocardial infarction (MI) ventricular septal defect (VSD) is a rare but potentially catastrophic mechanical complication that occurs in <1% of patients following a myocardial infarction and it is associated with a high morbidity and mortality despite improvements in medical and surgical therapies. Post-MI VSD is a medical emergency and outcome is very poor in medically treated patients. Treatment of choice remains surgical closure of defect and transcatheter defect closure less so. We performed a comprehensive review of the clinical presentation and management options of post-MI VSD.
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Affiliation(s)
- Muhammad Shahreyar
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN, United States of America
| | - Oluwaseun Akinseye
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN, United States of America
| | - Mannu Nayyar
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN, United States of America
| | - Uzair Ashraf
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN, United States of America
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN, United States of America.
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10
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Omar S, Morgan GL, Panchal HB, Thourani V, Rihal CS, Patel R, Kherada N, Egbe AC, Beohar N. Management of post-myocardial infarction ventricular septal defects: A critical assessment. J Interv Cardiol 2018; 31:939-948. [PMID: 30318677 DOI: 10.1111/joic.12556] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Post-myocardial infarction (MI) ventricular septal defects (PIVSD) are an uncommon but life-threatening complication of acute MI. Although surgical closure has been the standard of care, mortality, and recurrence of VSD remain high even after emergent surgery. Transcatheter VSD closure (TCC) devices have become an alternative or adjunct to surgical closure. METHODS Online database search was performed for studies that included adults with PIVSD who underwent medical treatment (MT) alone, surgical closure (SC) (early or late), and TCC (early, late, or for post-surgical residual VSD). RESULTS Twenty-six studies were included with a total of 737 patients who underwent either MT (N = 100), SC (early (n = 167), late (n = 100)), and TCC (early (n = 176), late (n = 115), or post-surgical residual VSD (n = 79)). The 30-day mortality among MT group was 92 ± 6.3%, among SC was 61 ± 22.5% (early 56 ± 23%, late 41 ± 30%), and for all TCC patients was 33 ± 24% (early 54 ± 32.7%, late 16 ± 26%), and TCC for post-surgical residual VSD 11 ± 34.9%. The mortality among overall SC, overall TCC and early TCC groups was significantly lower as compared with the MT (P < 0.001 for all comparisons). The overall mortality among all TCC, and late TCC groups was significantly lower when compared with the late SC (P < 0.0001, P < 0.0001, respectively). CONCLUSION Closure of PIVSD decreases mortality as compared with MT alone and should be attempted as early as possible after diagnosis. Selection of TCC versus SC should be based on factors including complexity of the defect, availability of closure devices, expertise of the operator, and clinical condition of patient.
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Affiliation(s)
- Sabry Omar
- Mount Sinai Medical Center, Columbia University Division of Cardiology, Miami Beach, Florida
| | - Garrison L Morgan
- Mount Sinai Medical Center, Columbia University Division of Cardiology, Miami Beach, Florida
| | - Hemang B Panchal
- Division of Cardiology, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Vinod Thourani
- Division of Cardiothoracic Surgery, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington, DC
| | - Charanjit S Rihal
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ruchi Patel
- Mount Sinai Medical Center, Columbia University Division of Cardiology, Miami Beach, Florida
| | - Nisharahmed Kherada
- Mount Sinai Medical Center, Columbia University Division of Cardiology, Miami Beach, Florida
| | - Alexander C Egbe
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nirat Beohar
- Mount Sinai Medical Center, Columbia University Division of Cardiology, Miami Beach, Florida
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11
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Kafes H, Ozeke O, Demirkan B, Acar B, Aysenur Ekizler F, Karabulut O, Can Konte H, Golbasi Z, Tufekcioglu O, Lutfi Kisacik H. Flail Tricuspid Leaflet During the Percutaneous Closure of Post-Myocardial Infarction Ventricular Septal Defect. ACTA ACUST UNITED AC 2018; 1:207-209. [PMID: 30062282 PMCID: PMC6058276 DOI: 10.1016/j.case.2017.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A post-MI ventricular septal defect is a complication of ST-elevation MI. Iatrogenic tricuspid regurgitations have not been reported after percutaneous closure. Care should be taken with the degree of tricuspid regurgitation to prevent iatrogenic tricuspid injury.
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Affiliation(s)
- Habibe Kafes
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Ozcan Ozeke
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Burcu Demirkan
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Burak Acar
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Firdevs Aysenur Ekizler
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Ozlem Karabulut
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Hasan Can Konte
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Zehra Golbasi
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Omac Tufekcioglu
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Halil Lutfi Kisacik
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
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12
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In-Hospital Outcomes and Long-Term Follow-Up after Percutaneous Transcatheter Closure of Postinfarction Ventricular Septal Defects. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7971027. [PMID: 28593177 PMCID: PMC5448058 DOI: 10.1155/2017/7971027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 11/19/2022]
Abstract
Postinfarction ventricular septal defects (VSD) represent a devastating complication of acute myocardial infarction and are associated with high mortality. Percutaneous interventional closure of postinfarction VSD has been proposed as a potential alternative to surgery. The study aimed to evaluate the therapeutic safety and efficacy of percutaneous interventional closure of postinfarction ventricular septal defects (VSD). Each patient was assigned to one of two groups, based on whether they died during hospitalization (death group) or survived (survival group) in this retrospective study. In-hospital and follow-up data were analyzed. Placement of the VSD occluder was successful in 12 procedures (80%). The mean defect size was 14.20 ± 4.89 mm. Compared to the patients who died, those who survived had higher systolic blood pressure, diastolic blood pressure, and left ventricular ejection fraction upon admission, as well as lower pulmonary/systemic flow ratio and shorter time from acute myocardial infarction to procedure. The incidence of cardiac shock and class IV heart failure was lower in the survival group than in the death group, and these factors correlated with in-hospital and 30-day mortality. Percutaneous closure of postinfarction VSD is an effective technique, which can be performed with a high procedural success rate.
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13
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Hamilton MC, Rodrigues JC, Martin RP, Manghat NE, Turner MS. The In Vivo Morphology of Post-Infarct Ventricular Septal Defect and the Implications for Closure. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2017.03.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Premchand RK, Garipalli R, Padmanabhan TNC, Manik G. Percutaneous closure of post-myocardial infarction ventricular septal rupture - A single centre experience. Indian Heart J 2016; 69 Suppl 1:S24-S27. [PMID: 28400035 PMCID: PMC5388014 DOI: 10.1016/j.ihj.2016.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/21/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of an acute myocardial infarction (AMI). Survival to 1 month without intervention is 6%. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. Indian data on percutaneous device closure of post AMI-VSR is scarce hence we report our single-centre experience with ASD occluder device (Amplatzer and lifetech) for closure of post-AMI VSR. METHODS AND RESULTS In this single-centre, retrospective, cohort study, patients who underwent transcatheter closure of post-MI VSR between 2005 and 2015 at KIMS Hospital were included. Primary outcome was mortality rate at 30 days. Seven patients were included in the study (mean age, 58.29±9.8 years). 5 patients had anterior wall myocardial infarction (AWMI) & 2 had inferior wall myocardial infarction (IWMI). None of the patients received thrombolytic therapy. Device was successfully placed in 5 patients (71.4%) with minimal residual shunt in 2 patients (40%). Out of 7 cases 2 patients survived (29% survival rate) and are doing well on follow up at 1 and 5 years respectively. Cardiogenic shock, IWMI and serpigenious form of VSR were associated with poor outcomes. Delayed revascularization (PCI) was associated with better outcomes. CONCLUSION Percutaneous closure is a potential technique in a selected group of patients. The presence of cardiogenic shock, IWMI and serpigeneous form of VSR constitutes important risk factors for mortality. Device implantation is in general successful with few procedure-related complications and should be applied on a case-by-case basis.
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Affiliation(s)
| | | | | | - Geetesh Manik
- Krishna Institute of Medical Sciences, Hyderabad, India
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15
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Schlotter F, de Waha S, Eitel I, Desch S, Fuernau G, Thiele H. Interventional post-myocardial infarction ventricular septal defect closure: a systematic review of current evidence. EUROINTERVENTION 2016; 12:94-102. [DOI: 10.4244/eijv12i1a17] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Lazkani M, Bashir F, Brady K, Pophal S, Morris M, Pershad A. Postinfarct VSD management using 3D computer printing assisted percutaneous closure. Indian Heart J 2015; 67:581-5. [PMID: 26702691 DOI: 10.1016/j.ihj.2015.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/13/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022] Open
Abstract
Postinfarct VSD (PIVSD) carries a grim prognosis. The mainstay of management has been surgical repair. The advent of septal occluder devices has offered an attractive alternative to surgical repair. Most PIVSD have serpiginous tracts with necrotic tissue, which makes assessing the defect challenging. 3D computer printing has become useful in preprocedure planning of complex surgical procedures in multiple subspecialties.
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Affiliation(s)
- Mohamad Lazkani
- Banner University Medical Center - Phoenix Campus, United States
| | | | - Kevin Brady
- Banner University Medical Center - Phoenix Campus, United States
| | | | - Michael Morris
- Banner University Medical Center - Phoenix Campus, United States
| | - Ashish Pershad
- Banner University Medical Center - Phoenix Campus, United States.
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17
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Ventricular septal rupture: A rare post-myocardial infarction complication with a very high mortality rate. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Capasso F, Caruso A, Valva G, Lonobile T, Grimaldi MG, Santoro G. Device closure of 'complex' postinfarction ventricular septal defect. J Cardiovasc Med (Hagerstown) 2015; 16 Suppl 1:S15-7. [PMID: 25643062 DOI: 10.2459/jcm.0b013e3283646f75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ventricular septal defect (VSD) is a life-threatening complication of acute myocardial infarction (MI), resulting in high mortality rate even in the case of a timely approach by surgical repair. Transcatheter closure is nowadays a reliable alternative to surgery, although currently deemed challenging or unsuitable in large and complex VSD. This article reports on a successful transcatheter approach in a critically ill patient with subacute right coronary-related, complex postinfarction VSD. In this patient, two sequentially deployed Amplatzer Septal Occluder devices stabilized the clinical conditions and hemodynamic parameters.
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Affiliation(s)
- Fabio Capasso
- aDepartment of Cardiology and Cardiac Surgery, Casa di Cura 'San Michele', Maddaloni, Italy bCardiology, A.O.R.N. 'Ospedali dei Colli', II University of Naples, Naples, Italy
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19
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Allende R, Ribeiro HB, Puri R, Urena M, Abdul-Jawad O, del Trigo M, Veiga G, Ortas MDR, Paradis JM, De Larochellière R, Rodés-Cabau J. The transradial approach during transcatheter structural heart disease interventions: a review. Eur J Clin Invest 2015; 45:215-25. [PMID: 25556629 DOI: 10.1111/eci.12398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 12/28/2014] [Indexed: 12/16/2022]
Abstract
AIMS To review the safety and feasibility of a transradial (TR) approach during transcatheter structural or congenital heart disease interventions when utilized as either as a primary or secondary arterial access site. METHODS AND RESULTS Studies and case reports published between 2002 and 2014 utilizing the TR access during transcatheter structural and congenital heart disease interventions during alcohol septal ablation (ASA), ventricular septal defect (VSD), renal denervation (RD), paravalvular leak (PVL) closure, transcatheter aortic valve implantation (TAVI, secondary access) and endovascular repair of aortic coarctation (ERAC, secondary access) were evaluated. Access-site (femoral vs. TR) vascular and bleeding complications were assessed. Femoral access complications ranged from 0.16% to 40%, with an overall incidence of 2.2% (56/2521). There were 18 reports or studies specifically evaluating the utility of TR access in the context of transcatheter structural heart disease interventions (ASA: 3; VSD: 1; RD: 3; PVL closure: 1; TAVI: 7, ERAC: 3). The use of TR access either as primary or secondary access site was feasible and allowed the completion of the procedure in all cases. The overall incidence of access-site complications following a TR approach was 0.5% (2/406 patients), with no major vascular or bleeding complications. CONCLUSIONS A TR approach during transcatheter structural heart disease interventions appears to be a safe, effective means of delivering high procedural success accompanied by lower bleeding complications compared with the transfemoral approach.
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20
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21
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Baldasare MD, Polyakov M, Laub GW, Costic JT, McCormick DJ, Goldberg S. Percutaneous repair of post-myocardial infarction ventricular septal defect: current approaches and future perspectives. Tex Heart Inst J 2014; 41:613-9. [PMID: 25593526 DOI: 10.14503/thij-13-3695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Post-myocardial infarction ventricular septal defect is a devastating complication of ST-elevation myocardial infarction. Although surgical intervention is considered the gold standard for treatment, it carries high morbidity and mortality rates. We present 2 cases that illustrate the application of percutaneous closure of a post-myocardial infarction ventricular septal defect: the first in a patient who had undergone prior surgical closure and then developed a new shunt, and the second as a bridge to definitive surgery in a critically ill patient.
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22
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Xu XD, Liu SX, Liu X, Chen Y, Li L, Qu BM, Wu ZY, Zhang DF, Zhao XX, Qin YW. Percutaneous closure of postinfarct muscular ventricular septal defects: A multicenter study in China. J Cardiol 2014; 64:285-9. [DOI: 10.1016/j.jjcc.2014.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/26/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
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23
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Dawson AG, Williams SG, Cole D. Does the placement of an Amplatzer septal occluder device confer benefit in patients with a post-infarction ventricular septal defect?: Table 1:. Interact Cardiovasc Thorac Surg 2014; 19:1040-7. [DOI: 10.1093/icvts/ivu293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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HEIBERG JOHAN, HJORTDAL VIBEKEELISABETH, NIELSEN-KUDSK JENSERIK. Long-Term Outcome after Transcatheter Closure of Postinfarction Ventricular Septal Rupture. J Interv Cardiol 2014; 27:509-15. [DOI: 10.1111/joic.12146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- JOHAN HEIBERG
- Department of Cardiothoracic and Vascular Surgery; Aarhus University Hospital; Aarhus N Denmark
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25
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Calvert PA, Cockburn J, Wynne D, Ludman P, Rana BS, Northridge D, Mullen MJ, Malik I, Turner M, Khogali S, Veldtman GR, Been M, Butler R, Thomson J, Byrne J, MacCarthy P, Morrison L, Shapiro LM, Bridgewater B, de Giovanni J, Hildick-Smith D. Percutaneous Closure of Postinfarction Ventricular Septal Defect. Circulation 2014; 129:2395-402. [DOI: 10.1161/circulationaha.113.005839] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background—
Postinfarction ventricular septal defect carries a grim prognosis. Surgical repair offers reasonable outcomes in patients who survive a healing phase. Percutaneous device implantation represents a potentially attractive early alternative.
Methods and Results—
Postinfarction ventricular septal defect closure was attempted in 53 patients from 11 centers (1997–2012; aged 72±11 years; 42% female). Nineteen percent had previous surgical closure. Myocardial infarction was anterior (66%) or inferior (34%). Time from myocardial infarction to closure procedure was 13 (first and third quartiles, 5–54) days. Devices were successfully implanted in 89% of patients. Major immediate complications included procedural death (3.8%) and emergency cardiac surgery (7.5%). Immediate shunt reduction was graded as complete (23%), partial (62%), or none (15%). Median length of stay after the procedure was 5.0 (2.0–9.0) days. Fifty-eight percent survived to discharge and were followed up for 395 (63–1522) days, during which time 4 additional patients died (7.5%). Factors associated with death after postinfarction ventricular septal defect closure included the following: age (hazard ratio [HR]=1.04;
P
=0.039), female sex (HR=2.33;
P
=0.043), New York Heart Association class IV (HR=4.42;
P
=0.002), cardiogenic shock (HR=3.75;
P
=0.003), creatinine (HR=1.007;
P
=0.003), defect size (HR=1.09;
P
=0.026), inotropes (HR=4.18;
P
=0.005), and absence of revascularization therapy for presenting myocardial infarction (HR=3.28;
P
=0.009). Prior surgical closure (HR=0.12;
P
=0.040) and immediate shunt reduction (HR=0.49;
P
=0.037) were associated with survival.
Conclusions—
Percutaneous closure of postinfarction ventricular septal defect is a reasonably effective treatment for these extremely high-risk patients. Mortality remains high, but patients who survive to discharge do well in the longer term.
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Affiliation(s)
- Patrick A. Calvert
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - James Cockburn
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Dylan Wynne
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Peter Ludman
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Bushra S. Rana
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - David Northridge
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Michael J. Mullen
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Iqbal Malik
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Mark Turner
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Saib Khogali
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Gruschen R. Veldtman
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Martin Been
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Rob Butler
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - John Thomson
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Jonathan Byrne
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Philip MacCarthy
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Lindsay Morrison
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Len M. Shapiro
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Ben Bridgewater
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Jo de Giovanni
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - David Hildick-Smith
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
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26
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Elasfar AA, Soofi MA, Kashour TS, Koudieh M, Galal MO. Transcatheter closure of residual postinfarction ventricular septal defect after dehiscence of surgical patch repair. Ann Saudi Med 2014; 34:171-4. [PMID: 24894788 PMCID: PMC6074864 DOI: 10.5144/0256-4947.2014.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ventricular septal defect (VSD) is a life-threatening complication of transmural myocardial infarction. Urgent surgical repair and concomitant revascularization are the standard of care. Percutaneous catheter-based closure techniques have been reserved for patients with a high-risk surgery or a failed surgical procedure with residual shunting. This case report demonstrates the successful transcatheter closure of residual VSD using the Amplatzer muscular VSD device (Amplatzer, Minnesota, USA) after surgical patch dehiscence for postinfarction VSD and 3-and-a-half years' post-intervention follow-up.
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Affiliation(s)
- Abdelfatah Abdelazim Elasfar
- Dr. Abdelfatah Elasfar, Department of Adult Cardiology,, Prince Salman Heart Center,, King Fahad Medical City,, Riyadh 59046,, Saudi Arabia, T: +966501852566, F: +966112889999 Ext 11113,
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27
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Abstract
Aims The aim of this systematic review is to gain insight into the published experience on percutaneous closure of a post-infarction ventricular septal rupture (VSR). Method Relevant literature was obtained by MeSH-term searches in the online search-engine PubMed. Articles published in the last 10 years were included. Further filtering was done by using search limits and individual article selection based on the aims of this systematic review. Conclusion Percutaneous closure is a potential technique in a select group of patients. The presence of cardiogenic shock and closure in the acute phase after VSR diagnosis are important risk factors of mortality. Device implantation is in general successful with few procedure-related complications. Reduction of the shunt fraction has been reported frequently. This technique is a less invasive alternative to surgical treatment and should be applied on a case-by-case basis.
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Ventricular septal rupture with hemodynamically important left-to-right shunt, right ventricular myocardial infarction, transient type III atrioventricular block and the development of left ventricular aneurysm as a complication of sub-acute myocardial infarction of the bottom wall accompanied by post-infarction unstable angina pectoris. COR ET VASA 2013. [DOI: 10.1016/j.crvasa.2013.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Jorge C, de Oliveira EI, Martins SR, Nobre A, da Silva PC, Diogo AN. Hybrid closure of postinfarction ventricular septal rupture enlargement after transcathether closure with Amplatzer occluder. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:57-9. [PMID: 24062890 DOI: 10.1177/2048872612441578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 01/16/2012] [Indexed: 11/15/2022]
Abstract
Ventricular septal rupture (VSR) is nowadays a rare complication of myocardial infarction (MI), but with a mortality rate still very high. Urgent surgical correction is recommended, although in specific cases percutaneous closure of a post-infarct VSR is a therapeutic option or a bridge to surgical correction. We report a case of an 80-year-old woman, with a subacute anterior MI with an antero-septal VSR. Rapid clinical deterioration in a high-surgical-risk patient led us to attempt percutaneous VSR closure at day 8 post MI. A 16-mm Amplatzer post-infarction (PI) muscular VSD closed the defect with intra-cardiac echocardiography guidance, that allowed conscious sedation. Clinical and haemodynamic improvement was immediate. Unfortunately, a small orifice distal to the device persisted, which enlarged to 8 mm over the following days, with a Qp/Qs shunt of 1.9. At day 17 post MI, the VSR was surgically closed by suturing the Amplatzer device to the septum. A residual shunt was evident, but with no progression, being the patient discharged in NYHA class I. Percutaneous closure of a post-MI VSR as a bridge to surgery is a therapeutic option in patients with high surgical risk, allowing haemodynamic stabilization and thus gaining time for a further surgical intervention if needed, improving these patients grim prognosis. Intra-cardiac echocardiography for monitoring the percutaneous procedure instead of a transoesophageal approach, as well as the surgical technique, make this case unique.
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Kommineni M, Lang RM, Russo MJ, Shah AP. Percutaneous transcatheter closure of infarct related ventricular septal defects assisted with portable miniaturized extracorporeal membrane oxygenation: A case series. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:241-5. [DOI: 10.1016/j.carrev.2013.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/22/2013] [Accepted: 06/03/2013] [Indexed: 11/24/2022]
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Matyal R, Wang A, Mahmood F. Percutaneous ventricular septal defect closure with Amplatzer devices resulting in severe tricuspid regurgitation. Catheter Cardiovasc Interv 2013; 82:E817-20. [PMID: 23553968 DOI: 10.1002/ccd.24803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 12/18/2012] [Accepted: 01/01/2013] [Indexed: 11/12/2022]
Abstract
While percutaneous intervention is an alternative for patients who are not surgical candidates, the rate of morbidity and mortality is comparable to open repair. Appending the reported complications associated with percutaneous intervention (device mal-positioning, dislodgement, and entrapment in the sub-valvular apparatus), we report mechanical damage to the tricuspid valve (TV). Percutaneous closure with an Amplatzer septal occluder device was attempted on three patients who developed a ventricular septal defects (VSD) after myocardial infarction. In all three cases, damage to the tricuspid leaflet was noted post-procedure. The accompanying severe tricuspid regurgitation led to right ventricular failure, even in the patients where the VSD was considered successfully occluded. Despite successful deployment of the Amplatzer device, complications with catheter manipulation may still arise. Damage to the TV can occur during percutaneous VSD closure with Amplatzer device. Periprocedure TEE monitoring can detect damage to the tricuspid leaflets.
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Affiliation(s)
- Robina Matyal
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Management, Boston, Massachusetts
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Patnaik AN, Barik R, Kumari NR, Gulati AS. Device closure of post-myocardial infarction ventricular septal defect three weeks after coronary angioplasty. J Cardiovasc Dis Res 2012; 3:155-9. [PMID: 22629038 PMCID: PMC3354463 DOI: 10.4103/0975-3583.95374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Percutaneus device closure appears to be safe and effective in patients treated for a residual shunt after initial surgical closure, as well as after two to three weeks of index myocardial infarction. The index case presented with a ventricular septal defect on second of acute myocardial infarction thrombolysed with streptokinase. The general condition of the patient was fairly stable. Cardiac catheterization and coronary angiography showed significant left to right shunt and there was 90 % proximal stenosis of left anterior descending coronary artery. Other coronary arteries were normal. Angioplasty and stenting to the coronary artery lesion was done using drug eluting stent (DES) with very good angiographic result. Patient was discharged after four days in stable condtion. After 3 weeks his ventricular septal defect was closed percutaneusly using cardio -O-fix device with tiny residual shunt. The procedure was uneventful and of brief duration. He was discharged after 5 days of the post procedure in very stable condition with minimal residual shunt. A staged procedure is a better option if the condition of the patient allows strengthening ventricular septal defect border.
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Affiliation(s)
- A N Patnaik
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
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Kulkarni M, Conte AH, Huang A, Lubin L, Shiota T, Kar S. Coronary artery disease, acute myocardial infarction, and a newly developing ventricular septal defect: surgical repair or percutaneous closure? J Cardiothorac Vasc Anesth 2011; 25:1213-6. [PMID: 21955832 DOI: 10.1053/j.jvca.2011.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Mona Kulkarni
- Division of Cardiothoracic Anesthesiology and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Deutsch-österreichische S3-Leitlinie „Infarktbedingter kardiogener Schock – Diagnose, Monitoring und Therapie“. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s00390-011-0284-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Eshtehardi P, Garachemani A, Meier B. Percutaneous closure of a postinfarction ventricular septal defect and an iatrogenic left ventricular free-wall perforation using two Amplatzer muscular VSD occluders. Catheter Cardiovasc Interv 2009; 74:243-6. [PMID: 19405157 DOI: 10.1002/ccd.21979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A 83-year-old woman underwent percutaneous closure of postinfarction ventricular septal defect following anteroseptal myocardial infarction and percutaneous coronary intervention with stent implantation of the left anterior descending coronary artery. Postinfarction percutaneous ventricular septal defect closure was initially complicated by an iatrogenic left ventricular free-wall perforation. Both defects were closed using two Amplatzer muscular VSD occluders during the same session.
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Affiliation(s)
- Parham Eshtehardi
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Transcatheter closure of a ventricular septal defect adjacent to a post infarction aneurysm using an atrial septal defect occluder. Clin Res Cardiol 2009; 98:275-7. [PMID: 19219389 DOI: 10.1007/s00392-009-0758-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
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Katetrizační uzávěr defektu komorového septa při infarktu myokardu. COR ET VASA 2008. [DOI: 10.33678/cor.2008.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Thiele H, Kaulfersch C, Daehnert I, Schoenauer M, Eitel I, Borger M, Schuler G. Immediate primary transcatheter closure of postinfarction ventricular septal defects. Eur Heart J 2008; 30:81-8. [PMID: 19036747 DOI: 10.1093/eurheartj/ehn524] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Holger Thiele
- Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Germany.
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