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Abstract
A review of the factors before, during and after surgical procedures that may predispose patients to post-operative wound infection
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Affiliation(s)
- M Briggs
- Centre for the Analysis of Nursing Practice, Leeds Community and Mental Health Teaching Trust
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2
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Abstract
Epidemiology can provide the knowledge necessary to allocate resources appropriately, but awareness of the advantages and disadvantages of different study methods is essential
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3
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Abstract
Eight patients with acute ventricular septal defect (VSD) receiving early intra-aortic balloon augmentation, cardiac catheterization, and open-heart surgery are described. Because of the large shunts in this group of patients, there was visualization of the right ventricle during left ventriculography which was adequate for qualitative analysis. The following were noted: (1) All patients had severe right ventricular (RV) dysfunction angiographically. (2) RV akinesis noted on angiography was more extensive than the surgical description of RV infarction, although all patients had biventricular infarction at surgery. (3) The RV dysfunction was the major cause of death (two cases) or a contributing factor (three cases). (4) RV papillary muscle rupture was identified in one case.
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4
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Rogers EW, Glassman RD, Feigenbaum H, Weyman AE, Godley RW. Aneurysms of the posterior interventricular septum with postinfarction ventricular septal defect. Echocardiographic identification. Chest 1980; 78:741-6. [PMID: 7428457 DOI: 10.1378/chest.78.5.741] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Using real-time, two-dimensional echocardiographic techniques, we recently studied six consecutive patients with acute myocardial infarction complicated by rupture of the posterior interventricular septum. Each patient experienced an inferior wall myocardial infarction, with a prior anteroseptal infarction in one. In each case, the clinical course was punctuated by the onset of heart failure and a low output state prior to, or coincident with, the appearance of a pansystolic murmur. During two-dimensional echocardiographic study, all six were found to have a discrete aneurysm of the posterior interventricular septum. Septal dyskinesis produced bulging of the interventricular septum far into the right ventricular cavity during systole. Our findings suggest that (1) septal dyskinesis and aneurysm formation may be a valuable sign in diagnosing ventricular septal performation; (2) the reported incidence of postinfarction septal aneurysm at surgery or autopsy may significantly underestimate its true frequency; and (3) septal dyskinesis must by considered as a contributing factor to the compromised hemodynamic status of patients with postinfarction ventricular septal rupture.
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5
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Montoya A, McKeever L, Scanlon P, Sullivan HJ, Gunnar RM, Pifarré R. Early repair of ventricular septal rupture after infarction. Am J Cardiol 1980; 45:345-8. [PMID: 7355743 DOI: 10.1016/0002-9149(80)90657-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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6
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Babb JD, Waldhausen JA, Zelis R. Balloon-induced right ventricular outflow obstruction: a new approach to control of acute interventricular shunting after myocardial infarction in canines and swine. Circ Res 1977; 40:372-9. [PMID: 844150 DOI: 10.1161/01.res.40.4.372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Current management of ventricular septal defect (VSD) after myocardial infarction (MI) is aimed at improving left ventricular (LV) performance by afterload reduction as a means of hemodynamic stabilization or shunt control. The current investigation was undertaken to determine whether primary manipulation of right venticular (RV) performance by afterload enhancement was an effective means of reducing MI-VSD shunting. In five open-chest dogs an external LV-RV shunt was created with pulmonary-systemic flow ratios (Qp/Qs) averaging 2.26:1. Inflation of a balloon-tipped catheter in the main pulmonary artery (PA) reduced average QP/Qs to 1.28:1 and shunt flow from 783 to 343 ml/min. However, this increase in RV afterload caused further significant increases in RV systolic and end-diastolic pressure and suggested that deterioration of RV function might be limiting the usefulness of this technique. To investigate whether inotropic support for the RV would overcome this limitation, a similar shunt was created in 11 open-chest swine. We then investigated the effects of dopamine, infused at 24, 60, and 120 mug/min, on QP/QS and other hemodynamic variables both with and without PA balloon inflation. Optimal shunt control was obtained when effects of dopamine were added to those of PA balloon inflation. Shunt flow that had been 1,633 ml/min was reduced to 892 ml/min with the PA balloon and reduced further to 757 ml/min with dopamine, which also lowered RV and LV end-diastolic pressure and reduced total systemic vascular resistance. In four other swine with left anterior descending ligations, PA balloon inflation and dopamine infusion again favorably affected hemodynamics. Epicardial mapping in these swine showed an increase in S-T segment displacement, suggesting that the cumulative effect of these interventions allowed hemodynamic improvement at the expense of enhanced ischemic injury. These data indicate that acute RV outflow obstruction with a balloon catheter is an effective means of temporarily reducing acute ventricular shunting and that dopamine may be a useful pharmacological agent to use with RV afterload manipulation to stabilize a patient prior to transfer to a medical center for more definitive therapy.
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7
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Iben AB, Miller RR, Amsterdam EA, Williams D, Hurley EJ, Hilliard GK, Caudill C, Zelis R, Mason DT. Successful immediate repair of acquired ventricular septal defect and survival in patients with acute myocardial infarction shock using a new double patch technique. Chest 1974; 66:665-70. [PMID: 4609695 DOI: 10.1378/chest.66.6.665] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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8
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Lufschanowski R, Angelini P, Del Rio C, Hallman GL, Cooley DA, Leachman RD. Ventricular septal rupture, secondary to myocardial infarction. Chest 1974; 65:59-63. [PMID: 4809334 DOI: 10.1378/chest.65.1.59] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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9
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Gonzalez-Lavin L, Zajtchuk R. Surgical considerations in the treatment of acute acquired ventricular septal defect. Thorax 1971; 26:610-4. [PMID: 4943957 PMCID: PMC472357 DOI: 10.1136/thx.26.5.610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In the light of our experience and that of others (Oldham et al., 1969; Iben, Pupello, Stinson, and Shumway, 1969), early surgical closure of acquired ventricular septal defect is advocated. Two successful cases are presented, one after myocardial infarction and one after penetrating trauma to the heart. Description of the present method of repair is presented. Two prosthetic patches are interposed in the closure of the defect. The advantages of this technique are (a) the key sutures are placed through healthy tissue and are anchored by the two patches, and (b) an additional suture line along the free edge of the right ventricular patch ensures a complete closure.
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Freeny PC, Schattenberg TT, Danielson GK, McGoon DC, Greenberg BH. Ventricular septal defect and ventricular aneurysm secondary to acute myocardial infarction. Report of four cases with successful surgical treatment. Circulation 1971; 43:360-4. [PMID: 5101738 DOI: 10.1161/01.cir.43.3.360] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Four cases of ventricular septal defect and ventricular aneurysm after myocardial infarction are reported. The clinical findings and surgical results in these four cases and in eight previously reported patients with this combination of complications are summarized. Resection of the ventricular aneurysm and closure of the ventricular septal defect appear indicated, both on theoretical grounds and in view of the excellent results observed in six patients who underwent combined repair. In one of our patients, closure of the ventricular septal defect and resection of the ventricular aneurysm were possible with only a single suture line, as these defects were anatomically contiguous.
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11
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12
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13
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Milstein BB. Exploring surgical treatment for myocardial infarction. BRITISH HEART JOURNAL 1970; 32:421-6. [PMID: 4914820 PMCID: PMC487347 DOI: 10.1136/hrt.32.4.421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Giannelli S, Ayres SM, Fleming P, Conrad W, Schwartz MS, Gould H. Peripheral vascular volumes and whole body hematocrit during human heart lung bypass. Circulation 1970; 41:629-40. [PMID: 5437407 DOI: 10.1161/01.cir.41.4.629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Indicator-dilution curves were obtained across the peripheral vascular bed in 15 patients soon after the beginning of heart lung bypass, and in eight of these persons they were repeated just prior to the conclusion of bypass. A bolus containing labelled red cells and albumin was injected into the arterial inflow line just proximal to the aorta. Serial blood samples were obtained at intervals of 1 second from the venous return line, just distal to the right atrium, and the radioactivity was measured. The interposed volume of blood in the pump oxygenator delayed recirculation, allowing extrapolation of the exponential downslope and calculation of flow rates and indicator distribution volumes by the Hamilton-Stewart equations.
The distribution volume of albumin (average, 56.3 ml/kg) was always greater than that of red cells (average, 44.8 ml/kg). The average ratio of whole body hematocrit to perfusate hematocrit was 0.873. The absence of significant differences between data obtained at the beginning and just prior to the end of bypass suggests that there were no alterations in venous tone or the volume relationships of large vessels to the microcirculation.
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Selzer A, Gerbode F, Kerth WJ. Clinical, hemodynamic, and surgical considerations of rupture of the ventricular septum after myocardial infarction. Am Heart J 1969; 78:598-607. [PMID: 5348744 DOI: 10.1016/0002-8703(69)90511-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Oldham HN, Scott SM, Dart CH, Fish RG, Claxton CP, Dillon ML, Sabiston DC. Surgical correction of ventricular septal defect following acute myocardial infarction. Ann Thorac Surg 1969; 7:193-201. [PMID: 5766741 DOI: 10.1016/s0003-4975(10)66171-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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18
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Partington T, Somerville J, Sellors TH, Resnekov L. Rupture of the ventricular septum from myocardial infarction. Haemodynamic response to surgical treatment. Thorax 1969; 24:118-23. [PMID: 5763504 PMCID: PMC471930 DOI: 10.1136/thx.24.1.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A patient aged 59 had a coronary thrombosis complicated by a ruptured ventricular septum. This was successfully repaired surgically about three months after the infarct, and some indications and problems connected with this procedure are discussed.
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Jeresaty RM, Landry AB, Stansel HC. Postinfarction interventricular septal defects. Report of two cases with long survival, one with surgical repair. Am Heart J 1967; 74:543-50. [PMID: 6047777 DOI: 10.1016/0002-8703(67)90014-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Honey M, Belcher JR, Hasan M, Gibbons JR. Successful early repair of acquired ventricular septal defect after myocardial infarction. Heart 1967; 29:453-6. [PMID: 6023741 PMCID: PMC459172 DOI: 10.1136/hrt.29.3.453] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Grismer JT, Raab DE, Berman DA, Berman R, Hill E. Successful repair of a ruptured ventricular septum complicating a recent myocardial infarction. Am J Cardiol 1966; 18:120-3. [PMID: 5938904 DOI: 10.1016/0002-9149(66)90204-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
A series of four patients who died following rupture of the ventricular septum due to myocardial infarction has been reported. One of these died of hemorrhage due to a defective clotting mechanism 8 hours after successful surgical repair.
The 13 cases of surgical repair of postinfarction ventricular septal defect reported by other authors are reviewed.
The time interval is important and preferably 3 to 6 months should elapse following myocardial infarction before surgery is undertaken.
Surgery should be considered in every patient diagnosed as having an acute septal rupture following myocardial infarction who fails to respond to vigorous medical treatment.
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