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Schlotter F, Huber K, Hassager C, Halvorsen S, Vranckx P, Pöss J, Krychtiuk K, Lorusso R, Bonaros N, Calvert PA, Montorfano M, Thiele H. Ventricular septal defect complicating acute myocardial infarction: diagnosis and management. A Clinical Consensus Statement of the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the ESC Working Group on Cardiovascular Surgery. Eur Heart J 2024; 45:2478-2492. [PMID: 38888906 DOI: 10.1093/eurheartj/ehae363] [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: 12/19/2023] [Revised: 03/26/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024] Open
Abstract
Ventricular septal defects are a rare complication after acute myocardial infarction with a mortality close to 100% if left untreated. However, even surgical or interventional closure is associated with a very high mortality and currently no randomized controlled trials are available addressing the optimal treatment strategy of this disease. This state-of-the-art review and clinical consensus statement will outline the diagnosis, hemodynamic consequences and treatment strategies of ventricular septal defects complicating acute myocardial infarction with a focus on current available evidence and a focus on major research questions to fill the gap in evidence.
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Affiliation(s)
- Florian Schlotter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Kurt Huber
- Departments of Cardiology and Intensive Care Medicine, Clinic Ottakring and Sigmund Freud University, Medical School, Vienna, Austria
| | | | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway
| | - Pascal Vranckx
- Department of Cardiology and Intensive Care Medicine, Heart Center Hasselt, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Janine Pöss
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Konstantin Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- Duke Clinical Research Institute, Durham, NC, USA
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Matteo Montorfano
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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Iyer V, Weiler C, Merhi W, Kar B, Fudge JC, Seshiah P, Mahadevan VS, Gutfinger D, Resar J. Transcatheter Closure of Postinfarct VSD With the Amplatzer PIVSD Occluder: Results of a US Study. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:102016. [PMID: 39132602 PMCID: PMC11307684 DOI: 10.1016/j.jscai.2024.102016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 08/13/2024]
Abstract
Background A postinfarct ventricular septal defect (PIVSD) is associated with high mortality and morbidity, particularly in patients with hemodynamic instability who are not suitable candidates for surgical repair. The Amplatzer PIVSD Occluder (Abbott) is indicated for transcatheter PIVSD closure in patients who are not satisfactory candidates for surgical repair. The objective of this study was to evaluate associated clinical outcomes. Methods A total of 131 patients underwent transcatheter PIVSD closure using the Amplatzer PIVSD Occluder between 2011 and 2021 as part of a postapproval, multicenter, retrospective, observational study. The patients were analyzed in 2 cohorts. Cohort 1 included 99 patients (age 68.6 ± 11.9 years) implanted from 2011 to 2016 and evaluated technical success, procedure survival, and 6-month survival. Cohort 2 included 32 patients (age 66.4 ± 10.9 years) implanted from 2012 to 2021 with postprocedure echocardiograms and evaluated 24-hour closure, 6-month closure, and 6-month survival. Results Technical success was achieved in 76.8% (76/99), procedure survival in 84.3% (75/89), and 6-month survival was observed in 37.2% of cohort 1 patients. Twenty-four-hour closure and 6-month closure were achieved in 53.1% (17/32) and 66.7% (4/6) of cohort 2 patients, respectively. Six-month survival was 46.4% of cohort 2 patients. Of the 16 deaths in cohort 2, 11 were cardiac-related, 4 were noncardiac-related, and 1 was of unknown etiology. Conclusions This study demonstrates high morbidity of patients undergoing PIVSD closure using the Amplatzer PIVSD Occluder and that the device continues to be a safe alternative to medical therapy in patients who are not satisfactory candidates for surgical repair of a PIVSD.
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Affiliation(s)
- Vijay Iyer
- Buffalo General Hospital, Buffalo, New York
| | | | | | | | - J. Curtis Fudge
- UF Health Shands Hospital, University of Florida, Gainesville, Florida
| | - Puvi Seshiah
- TriHealth Bethesda North Hospital, Cincinnati, Ohio
| | - Vaikom S. Mahadevan
- University of Massachusetts Chan School of Medicine, Worcester, Massachusetts
| | | | - Jon Resar
- The Johns Hopkins Hospital, Baltimore, Maryland
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Wang S, Liu H, Yang P, Wang Z, Chen S. Current Understanding of Timing of Surgical Repair for Ventricular Septal Rupture following Acute Myocardial Infarction. Cardiology 2024:1-14. [PMID: 38643761 DOI: 10.1159/000538967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Ventricular septal rupture (VSR) is a mechanical issue that can occur following an acute myocardial infarction (AMI) and has a high mortality rate. It requires a comprehensive, team-based approach for prompt diagnosis and maintaining stable blood flow. While the occurrence of VSR has lessened over the past hundred years and advancements have been made in treatment techniques, the mortality rate within 30 days can still surpass 40 percent. Surgery is the primary treatment method. For patients with stable blood flow, it is generally considered safer to perform surgery 4-6 weeks after the AMI to repair the VSR. However, the timing of surgery for patients with early instability in their blood flow is still a topic of debate. SUMMARY There is a lack of set criteria and standards to determine the best time for surgery in patients with VSR following an infarction who have unstable blood flow, especially when considering the use of blood circulation support devices and other techniques for maintaining blood flow that are used in clinical settings. KEY MESSAGES This review outlines the features of different mechanical circulatory support devices utilized in treating VSR, along with the current scoring system designed to direct the treatment approach for VSR patients.
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Affiliation(s)
- Shilin Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
| | - Hao Liu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peiwen Yang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiwen Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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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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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:55-161. [PMID: 37740496 DOI: 10.1093/ehjacc/zuad107] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
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Al-Bulushi A, Salmi IA, Ahmed AR, Rahbi FA. Post-Infarction Ventricular Septal Defect: A quarter century experience. Sultan Qaboos Univ Med J 2023; 23:22-30. [PMID: 38161766 PMCID: PMC10754311 DOI: 10.18295/squmj.12.2023.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/14/2023] [Accepted: 04/19/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives Post-infarction ventricular septal defect (VSD) is one of the known complications after acute myocardial infarction. This study investigated the clinical results after surgical repair of VSD. Methods This retrospective study included all patients undergoing surgical repair of VSD from 1996 to 2020 in Oman. Results Out of a total of 75 patients, 62.5% were men, with a mean age of 59 years. The mean follow-up was 17.2 (7.5) years. Of the 75 patients, 34 (45.3%) patients died within 30 days. Total survival was 41.3% at 5 years, while the 10-year survival rate was 33.3%. Outcomes and predictors for 30 days mortality were the number of concomitant coronary involvement and anastomoses performed, residual postoperative shunt and postoperative dialysis. Conclusion Even with surgical repair, early mortality of post-infarction septal defect is still considerably high. Early repair and the anatomically posterior rupture are predictors of early mortality. In patients surviving the immediate postoperative period, long-term survival is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt.
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Affiliation(s)
| | - Issa Al Salmi
- Medicine Department, The Royal Hospital, Muscat, Oman
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Williams AR, Moya-Mendez ME, Mehta S, Vekstein A, Harrison JK, Milano CA, Plichta RP, Haney J, Schroder JN, Zwischenberger B, Glower D, Gaca JG. Infarct exclusion repair of postmyocardial infarction ventricular septal rupture with a hybrid patch and septal occluder device compared with patch only. JTCVS Tech 2023; 22:228-236. [PMID: 38152175 PMCID: PMC10750469 DOI: 10.1016/j.xjtc.2023.07.022] [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] [Received: 05/28/2023] [Revised: 07/09/2023] [Accepted: 07/22/2023] [Indexed: 12/29/2023] Open
Abstract
Objective We developed a hybrid technique for repairing post-myocardial infarction (MI) ventricular septal defect (VSD) that combines infarct exclusion with patch and a nitinol-mesh septal occluder device (SOD) to provide a scaffold to support the damaged septal wall. Here, we compare outcomes of patients with post-MI VSD repaired using patch only or hybrid patch/SOD. Methods Patients undergoing post-MI VSD repair at our institution from 2013 to 2022 who received patch alone or patch/SOD repair were analyzed. Primary outcome was survival to hospital discharge. Clinical outcomes and echocardiograms were also analyzed. Results Over a 9-year period, 24 patients had post-MI VSD repair at our institution with either hybrid patch/SOD (n = 10) or patch only repair (n = 14). VSD size was 18 ± 5.8 mm for patch/SOD and 17 ± 4.6 mm for patch only. In the patch/SOD repair cohort, average size of SOD implant was 23.6 ± 5.6 mm. Mild left ventricular dysfunction was present prerepair and was unchanged postrepair in both groups; however, moderate-to-severe right ventricular (RV) dysfunction was common in both groups before repair. RV function worsened or persisted as severe in 10% of hybrid versus 54% of patch-only patients postrepair. Tricuspid annular systolic excursion and RV:left ventricle diameter ratio, quantitative metrics of RV function, improved after patch/SOD repair. No intraoperative mortality occurred in either group. Postoperative renal, hepatic, and respiratory failure requiring tracheostomy was common in both groups. Survival to hospital discharge in both cohorts was 70%. Conclusions Post-MI VSD repair with patch/SOD has comparable short-term outcomes with patch alone. Addition of a SOD to patch repair provides a scaffold that may enhance the repair of post-MI VSD with patch exclusion.
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Affiliation(s)
- Adam R. Williams
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Mary E. Moya-Mendez
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Sachin Mehta
- Division of Cardiothoracic Anesthesia, Department of Anesthesia, Duke University Hospital, Durham, NC
| | - Andrew Vekstein
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - J. Kevin Harrison
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, NC
| | - Carmelo A. Milano
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Ryan P. Plichta
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - John Haney
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Jacob N. Schroder
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Brittany Zwischenberger
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Donald Glower
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Jeffrey G. Gaca
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
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González-Pacheco H, Ortega-Hernandez JA, Meza-López JÁ, Soliz-Uriona LA, Manzur-Sandoval D, Gopar-Nieto R, Araiza-Garaygordobil D, Sierra-Lara D, Arias-Sánchez E, Sandoval JP, Altamirano-Castillo A, Mendoza-García S, Arzate-Ramírez A, Baranda-Tovar FM, Martinez H, Montañez-Orozco Á, Baeza-Herrera LA, Sierra-González De Cossio A, Arias-Mendoza A. Analysis of immortal-time effect in post-infarction ventricular septal defect. Front Cardiovasc Med 2023; 10:1270608. [PMID: 37928756 PMCID: PMC10620744 DOI: 10.3389/fcvm.2023.1270608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Time-fixed analyses have traditionally been utilized to examine outcomes in post-infarction ventricular septal defect (VSD). The aims of this study were to: (1) analyze the relationship between VSD closure/non-closure and mortality; (2) assess the presence of immortal-time bias. Material and methods In this retrospective cohort study, patients with ST-elevation myocardial infarction (STEMI) complicated by VSD. Time-fixed and time-dependent Cox regression methodologies were employed. Results The study included 80 patients: surgical closure (n = 26), transcatheter closure (n = 20), or conservative management alone (n = 34). At presentation, patients without VSD closure exhibited high-risk clinical characteristics, had the shortest median time intervals from STEMI onset to VSD development (4.0, 4.0, and 2.0 days, respectively; P = 0.03) and from STEMI symptom onset to hospital arrival (6.0, 5.0, and 0.8 days, respectively; P < 0.0001). The median time from STEMI onset to closure was 22.0 days (P = 0.14). In-hospital mortality rate was higher among patients who did not undergo defect closure (50%, 35%, and 88.2%, respectively; P < 0.0001). Closure of the defect using a fixed-time method was associated with lower in-hospital mortality (HR = 0.13, 95% CI 0.05-0.31, P < 0.0001, and HR 0.13, 95% CI 0.04-0.36, P < 0.0001, for surgery and transcatheter closure, respectively). However, when employing a time-varying method, this association was not observed (HR = 0.95, 95% CI 0.45-1.98, P = 0.90, and HR 0.88, 95% CI 0.41-1.87, P = 0.74, for surgery and transcatheter closure, respectively). These findings suggest the presence of an immortal-time bias. Conclusions This study highlights that using a fixed-time analytic approach in post-infarction VSD can result in immortal-time bias. Researchers should consider employing time-dependent methodologies.
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Affiliation(s)
| | | | | | | | | | | | | | - Daniel Sierra-Lara
- Coronary Care Unit, National Institute of Cardiology, Mexico City, Mexico
| | - Eduardo Arias-Sánchez
- Department of Interventional Cardiology, National Institute of Cardiology, Mexico City, Mexico
| | - Juan Pablo Sandoval
- Department of Interventional Cardiology, National Institute of Cardiology, Mexico City, Mexico
| | | | | | | | | | - Humberto Martinez
- Department of Cardiovascular Surgery, National Institute of Cardiology, Mexico City, Mexico
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720-3826. [PMID: 37622654 DOI: 10.1093/eurheartj/ehad191] [Citation(s) in RCA: 707] [Impact Index Per Article: 707.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Arsh H, Pahwani R, Arif Rasool Chaudhry W, Khan R, Khenhrani RR, Devi S, Malik J. Delayed Ventricular Septal Rupture Repair After Myocardial Infarction: An Updated Review. Curr Probl Cardiol 2023; 48:101887. [PMID: 37336311 DOI: 10.1016/j.cpcardiol.2023.101887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
Ventricular septal rupture (VSR) is a rare but serious complication that can occur after myocardial infarction (MI) and is associated with significant morbidity and mortality. The optimal management approach for VSR remains a topic of debate, with considerations including early versus delayed surgery, risk stratification, pharmacological interventions, minimally invasive techniques, and tissue engineering. The pathophysiology of VSR involves myocardial necrosis, inflammatory response, and enzymatic degradation of the extracellular matrix (ECM), particularly mediated by matrix metalloproteinases (MMPs). These processes lead to structural weakening and subsequent rupture of the ventricular septum. Hemodynamically, VSR results in left-to-right shunting, increased pulmonary blood flow, and potentially hemodynamic instability. The early surgical repair offers the advantages of immediate closure of the defect, prevention of complications, and potentially improved outcomes. However, it is associated with higher surgical risk and limited myocardial recovery potential during the waiting period. In contrast, delayed surgery allows for a period of myocardial recovery, risk stratification, and optimization of surgical outcomes. However, it carries the risk of ongoing complications and progression of ventricular remodeling. Risk stratification plays a crucial role in determining the optimal timing for surgery and tailoring treatment plans. Various clinical factors, imaging assessments, scoring systems, biomarkers, and hemodynamic parameters aid in risk assessment and guide decision-making. Pharmacological interventions, including vasopressors, diuretics, angiotensin-converting enzyme inhibitors, beta-blockers, antiplatelet agents, and antiarrhythmic drugs, are employed to stabilize hemodynamics, prevent complications, promote myocardial healing, and improve outcomes in VSR patients. Advancements in minimally invasive techniques, such as percutaneous device closure, and tissue engineering hold promise for less invasive interventions and better outcomes. These approaches aim to minimize surgical morbidity, optimize healing, and enhance patient recovery. In conclusion, the management of VSR after MI requires a multidimensional approach that considers various aspects, including risk stratification, surgical timing, pharmacological interventions, minimally invasive techniques, and tissue engineering.
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Affiliation(s)
- Hina Arsh
- Department of Medicine, THQ Hospital, Pasrur, Pakistan
| | - Ritesh Pahwani
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Rubaiqa Khan
- Department of Neurosurgery, Sherwan Rural Health Center, Sherwan, Pakistan
| | - Raja Ram Khenhrani
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Sapna Devi
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Research, Cardiovascular Analytics Group, Islamabad, Pakistan.
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Garg P, Lykins A, Alomari M, Pollak P, Patel P, Sareyyupoglu B. Case report: Heart transplant for persistent right heart failure after complete surgical repair and percutaneous closure of post-myocardial infarction ventricular septal rupture. Front Cardiovasc Med 2023; 10:1237772. [PMID: 37790593 PMCID: PMC10543756 DOI: 10.3389/fcvm.2023.1237772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
The incidence of post-acute myocardial infarction ventricular septal rupture (post-AMI VSR) has decreased; however, mortality after surgical repair of post-AMI VSR remains high. Patients who are not surgical candidates can be managed by heart transplant with a good outcome. A heart transplant in a patient after successful repair of VSR has never been reported. We report a patient who had persistent right heart failure after the successful repair of VSR and underwent a heart transplant with a good outcome.
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Affiliation(s)
- Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Amy Lykins
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Peter Pollak
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida
| | - Parag Patel
- Department of Transplant, Division of Advanced Heart Failure and Cardiac Transplant, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
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12
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Tanto IV, Dharma S, Juzar DA, Bono AA. Ventricular Septal Rupture Complicating an Acute ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic. Int J Angiol 2023; 32:194-196. [PMID: 37576532 PMCID: PMC10421677 DOI: 10.1055/s-0040-1720971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/17/2020] [Indexed: 10/22/2022] Open
Abstract
Ventricular septal rupture (VSR) is rare but a lethal complication of acute myocardial infarction (MI). Definite treatment requires the surgical closure of the VSR and coronary artery bypass grafting (CABG). However, the optimal timing for surgery is still controversial, particularly during the novel coronavirus disease 2019 (COVID-19) pandemic where medical procedures should be performed within the safest environment. Before surgery, a proper management in the intensive cardiovascular care unit is essential to maintain the stability of the hemodynamic profile related with VSR and determines the prognosis of the patient. We described a case of VSR complicating an anterior wall MI in a patient who admitted to our hospital during the COVID-19 pandemic that was treated successfully by surgical closure of the VSR and CABG.
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Affiliation(s)
- Ines V. Tanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dafsah A. Juzar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Arinto A.H. Bono
- Division of Cardiothoracic and Vascular Surgery, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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13
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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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14
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Cadogan D, Daghem M, Snosi M, Williams LK, Weir-McCall J, Calvert PA, Giblett JP. Percutaneous Transcatheter Closure of Post-infarction Ventricular Septal Defect: An Alternative to Surgical Intervention. Interv Cardiol 2023; 18:e19. [PMID: 37435604 PMCID: PMC10331564 DOI: 10.15420/icr.2023.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/03/2023] [Indexed: 07/13/2023] Open
Abstract
Post-infarction ventricular septal defect is a mechanical complication of acute MI. The incidence of this complication is low in the primary percutaneous coronary intervention era. However, the associated mortality is very high at 94% with medical management alone. Open surgical repair or percutaneous transcatheter closure still has an in-hospital mortality >40%. Retrospective comparisons between both closure methods are limited by observation and selection bias. This review addresses the assessment and optimisation of patients prior to repair, the optimal timing of repair, and the limitations in current data. The review considers techniques for percutaneous closure, and finally considers the path that future research should take to improve outcomes for patients.
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Affiliation(s)
- Diarmaid Cadogan
- Department of Cardiology, Liverpool Heart and Chest HospitalLiverpool, UK
| | - Marwa Daghem
- Department of Cardiology, Liverpool Heart and Chest HospitalLiverpool, UK
| | - Mostafa Snosi
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest HospitalUK
| | | | - Jonathan Weir-McCall
- Department of Radiology, Royal Papworth HospitalCambridge, UK
- Division of Cardiovascular Medicine, University of CambridgeCambridge, UK
| | - Patrick A Calvert
- Department of Cardiology, Royal Papworth HospitalCambridge, UK
- Division of Cardiovascular Medicine, University of CambridgeCambridge, UK
| | - Joel P Giblett
- Department of Cardiology, Liverpool Heart and Chest HospitalLiverpool, UK
- Liverpool Centre for Cardiovascular Science, University of LiverpoolLiverpool, UK
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15
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Chen T, Liu Y, Zhang J, Sun Z, Han Y, Gao C. Percutaneous closure of ventricular septal rupture after myocardial infarction: A retrospective study of 81 cases. Clin Cardiol 2023. [PMID: 37190920 DOI: 10.1002/clc.24027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/09/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of percutaneous closure of ventricular septal rupture (VSR) after acute myocardial infarction (AMI). METHODS This retrospective study included 81 patients who underwent transcatheter closure for postinfarction VSR. We analyzed clinical data from hospitalization and the 30-day follow-up, compared clinical data from the survival and death groups, and explored the best closure time and the safety and efficacy of occlusion. The risk factors for death at 30 days were analyzed by logistic regression. RESULTS C-reactive protein (CRP), white blood cell counts, N-terminal pro brain natriuretic peptide (NT-ProBNP), and aspartate aminotransferase were higher in the death group than in the survival group (p < .01), with a higher rate of application of vasoactive drugs, and a shorter time from AMI to operation (p < .05). At 30 days postocclusion, 19 patients (23.5%) had died. The mortality rate was significantly lower for operation performed 3 weeks after AMI than for operation performed within 3 weeks of AMI (12.5% vs. 48%, p < .001). Devices were successfully implanted in 76 patients, with 16 (21.1%) operation-related complications and 12 (15.8%) valve injuries. Cardiac function improved significantly (p < .001) at discharge (N = 66) and 30 days after procedure (N = 62). Qp/Qs and pulmonary artery systolic pressure decreased significantly, while aortic systolic pressure increased significantly (p < .001). Additionally, EF and LVDd improved (p < .05) after occlusion. Increases in CRP and NT-ProBNP were risk factors for death at 30 days after closure (p < .05). CONCLUSION Percutaneous VSR closure can be a valuable treatment option for suitable patients with VSR.
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Affiliation(s)
- Tongfeng Chen
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuhao Liu
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Zhang
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Zirui Sun
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Han
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Chuanyu Gao
- Henan Key Laboratory of Coronary Heart Disease Control, Heart Center of Henan Provincial People's Hospital, Henan Research Center for Cardiovascular Epidemiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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16
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Bagaria V, Hiremath CS. Post myocardial infarction ventricular septal rupture-protracted hemolysis due to missed additional ventricular septal defect. Indian J Thorac Cardiovasc Surg 2023; 39:278-281. [PMID: 37124588 PMCID: PMC10140199 DOI: 10.1007/s12055-022-01470-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/27/2023] Open
Abstract
Hemolysis is a known and usually self-limiting complication of transcatheter device closure of post-myocardial infarction ventricular septal rupture (VSR). Multiple defects, serpiginous pathways, friable margins, left ventricular aneurysms, and improper size of the device have been described as causes for persistent residual shunt across the device. We report a case of protracted hemolysis after device closure of VSR requiring surgical intervention. During device retrieval and patch closure, a muscular band was observed dividing the VSR into two, allowing residual shunt across the second defect. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-022-01470-8.
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Affiliation(s)
- Vivek Bagaria
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066 India
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17
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Zhu Y, Luo S, Zeng C, Huang B. Ventricular septal rupture after acute myocardial infarction in a patient with venous thromboembolism complicated by thrombocytopenia: A case report. Clin Case Rep 2023; 11:e7059. [PMID: 36911635 PMCID: PMC9994429 DOI: 10.1002/ccr3.7059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
A woman that suffered burns previously presented with leg swelling and was diagnosed with venous thromboembolism. Heparin was given until she suddenly developed myocardial infarction. Ventricular septal rupture was detected and managed by transcatheter closure. She developed massive bleeding and extensive thrombosis that made treatment paradoxical and eventually died.
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Affiliation(s)
- Yuansong Zhu
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Suxin Luo
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Chun Zeng
- Department of RadiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Bi Huang
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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18
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Perez-Villa B, Cubeddu RJ, Brozzi N, Sleiman JR, Navia J, Hernandez-Montfort J. Transition to heart transplantation in post-myocardial infarction ventricular septal rupture: a systematic review. Heart Fail Rev 2023; 28:217-227. [PMID: 34674096 DOI: 10.1007/s10741-021-10161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
Post-myocardial infarction ventricular septal rupture (MI-VSR) remains a dreadful complication with dismal prognosis. Surgical repair is the primary treatment strategy, whereas the role of heart transplantation (HT) as a primary option in MI-VSR is limited to case reports (CRs). We performed a systematic review of CRs to describe in-hospital mortality, and survival at 6 and 12 months in adult patients with MI-VSR treated with HT as a primary or bailout strategy. We performed a comprehensive search of Web of Science, PubMed, and Ovid Medline. The last search was completed on March 10, 2020. An aggregated score based on the CARE case report guideline was used to assess the quality of the CRs. We included CRs that described adult patients with MI-VSR treated with HT as a primary or bailout strategy. A total of 14 CRs between 1994 and 2015 were included, retrieving and analyzing the characteristics of 17 patients. A total of 12 patients underwent HT, with HT being the primary strategy in 8 patients and a bailout strategy for 4 patients following initial surgical repair, while 5 patients died awaiting HT under mechanical circulatory support (MCS), accounting for the total in-hospital mortality of this series (29%). Regarding long-term outcomes, 6 patients were reported to be alive at 6 months and 1 year after HT, while information was missing in the remaining 6 patients. In conclusion, HT supported by the use of temporary and durable MCS as a bridge to HT could be a feasible primary or bailout strategy to reduce the high in-hospital mortality of patients with MI-VSR.
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Affiliation(s)
- Bernardo Perez-Villa
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, FL, Weston, USA.
| | | | - Nicolas Brozzi
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, FL, Weston, USA
| | - Jose R Sleiman
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, FL, Weston, USA
| | - Jose Navia
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, FL, Weston, USA
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19
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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: 25] [Impact Index Per Article: 12.5] [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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20
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Piriou PG, Guerin P, Plessis J, Senage T, Manigold T, Auffret V, Didier R, Le Ruz R, David CH, Roussel JC, Letocart V. Management and outcomes of ventricular septal defects after acute myocardial infarction: A multicenter retrospective study. J Card Surg 2022; 37:5019-5026. [PMID: 36378912 DOI: 10.1111/jocs.17151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIM The mortality rate of patients with post-myocardial infarction (MI) ventricular septal defects (VSDs) is high, and the benefit of surgery is unclear. We aimed to investigate the management and outcomes of post-MI VSD over a 10-year period in a large cohort. METHODS Data of patients with post-MI VSD admitted in three French university hospitals from 2008 to 2019 were examined. The characteristics of those who underwent surgery were compared with those who received medical treatment. Mortality risk factors, survival curves, and outcomes at 30 days and 1 year after treatment were determined. RESULTS Of the 92 patients whose data were examined, 50 underwent surgery and 42 received exclusive medical treatment. All patients were critically ill. Overall, 76.1% of patients received inotropic support, and 63% received mechanical ventilation. Circulatory assistance, mainly via intra-aortic balloon pump and extra-corporeal membrane oxygenation, was provided to 46.7% patients, with 14.1% requiring a second assistance. The median time to surgery was 4 days. At 1 year, mortality was 46% in those who underwent surgery and 83.3% in those treated medically (p < .001). Survival curves at 1 and 3 months showed major differences, and the survival rate showed little change 30 days after treatment. Cardiogenic shock and cardiac arrest emerged as risk factors for mortality. CONCLUSIONS In our retrospective, multicenter study, the mortality resulting from post-MI VSD did not seem to improve over the last decade. Although surgery carried considerable risks, it improved survival.
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Affiliation(s)
- Pierre-Guillaume Piriou
- Department of Cardiology, Nantes Université, CHU Nantes, l'institut du thorax, Nantes, France
| | - Patrice Guerin
- Department of Cardiology, Nantes Université, CHU Nantes, l'institut du thorax, Nantes, France
| | - Julien Plessis
- Department of Cardiology, Nantes Université, CHU Nantes, l'institut du thorax, Nantes, France
| | - Thomas Senage
- Department of Thoracic and Cardio-Vascular Surgery, Nantes Université, CHU Nantes, l'institut du thorax, Nantes, France
| | - Thibaut Manigold
- Department of Cardiology, Nantes Université, CHU Nantes, l'institut du thorax, Nantes, France
| | | | | | - Robin Le Ruz
- Department of Cardiology, Nantes Université, CHU Nantes, l'institut du thorax, Nantes, France
| | - Charles-Henri David
- Department of Thoracic and Cardio-Vascular Surgery, Nantes Université, CHU Nantes, l'institut du thorax, Nantes, France
| | - Jean-Christian Roussel
- Department of Thoracic and Cardio-Vascular Surgery, Nantes Université, CHU Nantes, l'institut du thorax, Nantes, France
| | - Vincent Letocart
- Department of Cardiology, Nantes Université, CHU Nantes, l'institut du thorax, Nantes, France
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21
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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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22
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Ma D, Zhang Z, Zhang S, Wang Z, Zhang G, Wang C, Xi J. Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience. Front Cardiovasc Med 2022; 9:843625. [PMID: 35265690 PMCID: PMC8899464 DOI: 10.3389/fcvm.2022.843625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To analyze treatment strategies, prognosis, and related risk factors of patients with postinfarction ventricular septal rupture, as well as the impact of timing of surgical intervention. Methods A total of 23 patients diagnosed with postinfarction ventricular septal rupture who were non-selectively admitted to Shanxi Provincial Cardiovascular Hospital between October 2017 and August 2021 were included in this study. The relevant clinical data, operation-related conditions, and follow-up data were summarized for all patients. The Kaplan-Meier method and log-rank test were used for the cumulative incidence of unadjusted mortality in patients with different treatment methods. Multivariate logistic regression was used to evaluate the independent risk factors for in-hospital patient mortality. Results The mean age of the study patients was 64.43 ± 7.54 years, 12(52.2%) were females. There was a significant difference in terms of postoperative residual shunt between the surgical and interventional closure groups (5.9 vs. 100%, respectively; P < 0.001). The overall in-hospital mortality rate was 21.7%; however, even though the surgical group had a lower mortality rate than the interventional closure group (17.6 vs. 33%, respectively), this difference was not statistically significant (P = 0.576). Univariate analysis showed that in-hospital survival group patients were significantly younger than in-hospital death group patients (62.50 ± 6.53 vs. 71.40 ± 7.37 years, respectively; P = 0.016), and that women had a significantly higher in-hospital mortality rate than men (P = 0.037). The average postoperative follow-up time was 18.11 ± 13.92 months; as of the end of the study all 14 patients in the surgical group were alive, Two out of four patients survived and two patients died after interventional closure. Univariate analysis showed that interventional closure was a risk factor for long-term death (P < 0.05). Conclusion Surgical operation is the most effective treatment for patients with postinfarction ventricular septal rupture; however, the best timing of the operation should be based on the patient's condition and comprehensively determined through real-time evaluation and monitoring. We believe that delaying the operation time as much as possible when the patient's condition permits can reduce postoperative mortality. Interventional closure can be used as a supplementary or bridge treatment for surgical procedures.
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Affiliation(s)
- Dongliang Ma
- Department of Cardiovascular Surgery, Shanxi Provincial Cardiovascular Hospital, Shanxi Provincial Institute of Cardiovascular Diseases, Taiyuan, China
| | - Zhibiao Zhang
- Department of Cardiovascular Surgery, Shanxi Provincial Cardiovascular Hospital, Shanxi Provincial Institute of Cardiovascular Diseases, Taiyuan, China
| | - Shunye Zhang
- Department of Cardiovascular Surgery, Shanxi Provincial Cardiovascular Hospital, Shanxi Provincial Institute of Cardiovascular Diseases, Taiyuan, China
| | - Zhongchao Wang
- Department of Cardiology, Shanxi Provincial Cardiovascular Hospital, Shanxi Provincial Institute of Cardiovascular Diseases, Taiyuan, China
| | - Gang Zhang
- Department of Anesthesiology, Shanxi Provincial Cardiovascular Hospital, Shanxi Provincial Institute of Cardiovascular Diseases, Taiyuan, China
| | - Chongjun Wang
- Department of Cardiovascular Surgery, Shanxi Provincial Cardiovascular Hospital, Shanxi Provincial Institute of Cardiovascular Diseases, Taiyuan, China
| | - Jicheng Xi
- Department of Cardiovascular Surgery, Shanxi Provincial Cardiovascular Hospital, Shanxi Provincial Institute of Cardiovascular Diseases, Taiyuan, China
- *Correspondence: Jicheng Xi
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The Clinical Outcomes of Ventricular Septal Rupture Secondary to Acute Myocardial Infarction: A Retrospective, Observational Trial. J Interv Cardiol 2022; 2021:3900269. [PMID: 34987315 PMCID: PMC8692018 DOI: 10.1155/2021/3900269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/17/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023] Open
Abstract
Background Ventricular septal rupture (VSR) is a severe mechanical complication secondary to acute myocardial infarction (AMI) with a dreadful prognosis. The goal of our study was to evaluate the mortality and to identify the predictors of mortality for this population. Methods From June 2012 to July 2021, patients with VSR secondary to AMI were initially screened for eligibility in this study. The potential risk predictors were determined using appropriate logistic regression models. Results In this retrospective study, a total of 50 cases were included, and 14 patients survived and got discharged successfully. Univariable analyses indicated that the heart rate (HR), white blood cell (WBC) count, neutrophils count, serum glucose, serum creatinine, serum lactic acid, and the closure of rupture were significantly associated with mortality among these special populations. Conclusion This study found that such high mortality in patients with VSR after AMI was significantly correlated with these risk factors representing sympathetic excitation and large infarct size. Coronary revascularization combined with the closure of rupture might be helpful in improving their prognosis.
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Yang C, Sun Y, Zou D, Sun Z, Zhang X, Su G, Qi J, Pang W. Transcatheter closure of ventricular septal rupture with prolonged support of intra-aortic balloon pump after primary PCI: a case report. BMC Cardiovasc Disord 2021; 21:605. [PMID: 34922437 PMCID: PMC8684637 DOI: 10.1186/s12872-021-02392-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ventricular septal rupture (VSR) is a rare but severe complication of acute myocardial infarction (AMI). For such cases, surgical repair is recommended by major guidelines, but not always possible for such cases. CASE PRESENTATION A 72-year-old man presented to the emergency room. ECG showed the ST-segment was elevated by 2-3 mm in lead II, III, and aVF, with Q-waves. Coronary angiography (CAG) showed multi-vessel disease with a total occlusion of the right coronary artery (RCA) and severe stenosis of the left anterior descending artery (LAD). A diagnosis of acute inferior myocardial infarction was made. VSR occurred immediately after percutaneous coronary intervention (a 2.5 × 20 mm drug-eluting stent implanted in RCA), and the patient developed cardiogenic shock. An intra-aortic balloon pump (IABP) was used to stabilize the hemodynamics. Transthoracic echocardiography (TTE) revealed an 11.4-mm left-to-right shunt in the interventricular septum. An attempt was made to reduce the IABP augmentation ratio for weaning on day 12 but failed. Transcatheter closure was conducted using a 24-mm double-umbrella occluder on day 28. The patient was weaned from IABP on day 31 and underwent secondary PCI for LAD lesions on day 35. The patient was discharged on day 41. Upon the last follow-up 6 years later, CAG and TTE revealed no in-stent restenosis, no left-to-right shunt, and 51% left ventricular ejection fraction. CONCLUSIONS Prolonged implementation of IABP can be a viable option to allow deferred closure of VSR in AMI patients, and transcatheter closure may be considered as a second choice for the selected senior and vulnerable patients, but the risk is still high.
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Affiliation(s)
- Chuan Yang
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Yong Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, 150086, China
| | - Deling Zou
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Xinzhong Zhang
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Guangsheng Su
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Jing Qi
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Wenyue Pang
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China.
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Complicating Acute Myocardial Infarction. Current Status and Unresolved Targets for Subsequent Research. J Clin Med 2021; 10:jcm10245904. [PMID: 34945202 PMCID: PMC8705405 DOI: 10.3390/jcm10245904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Mechanical reperfusion with primary angioplasty, as the treatment of choice in acute myocardial infarction (MI), is associated not only with a high percentage of full epicardial and tissue reperfusion but also with a very good immediate and long-term clinical outcome. However, the Achilles heel of MI treatment is its ensemble of complications, such as cardiogenic shock due to severe systolic and/or diastolic dysfunction or MI mechanical complications, including perforation of the left ventricular free wall, papillary muscle rupture with acute mitral regurgitation and ventricular septal rupture. They are associated with an increased or, sometimes, with an extremely high mortality rate, determining the overall mortality in an MI patient population. In this review we summarize the mechanisms of MI complications, current therapeutic management and alternative directions for overcoming their devastating consequences. Moreover, we have sought to indicate gaps in the evidence on current treatments as the potential targets for further clinical research. From the perspective of mortality trends that are not improving, the forthcoming therapeutic management of complicated MI will require an individualized and novel approach based on their thorough pathobiology.
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Yang X, Yu Z, Wang Y, Ding Y, Ni R, Xiao P. Transcatheter closure for postinfarction ventricular septal defect: A meta-analysis of the current evidence. J Card Surg 2021; 36:4625-4633. [PMID: 34499370 DOI: 10.1111/jocs.15989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/17/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Postinfarction ventricular septal defect (PIVSD) is a severe complication of acute myocardial infarction (AMI). Transcatheter closure (TCC) is an alternative option to surgical repair. This study was undertaken to examine the published literature to provide objective evidence for TCC using a meta-analysis. METHODS We searched for significant medical and publisher databases. Two reviewers checked the quality of the studies and extracted data. Eligible studies included single-arm studies and comparative studies. Weighted means, pooled event rates, efficacy outcomes and odds ratios (ORs) for immediate shunt reduction (ISR), presence of cardiogenic shock (CS), New York Heart Association (NYHA) class IV, time from AMI to ventricular septal defect (VSD), and time to VSD closure was estimated. RESULTS A total of 27 single-arm articles (462 patients) were included. The pooled event rate was 89.7% (95% confidence interval [CI]: 0.772-1.021) for successful device implantation, 80.9% (95% CI: 0.645-0.972) for ISR, 31.5% (95% CI: 0.149-0.482) for 30-day mortality, and 25.3% (95% CI: 0.072-0.434) for 30-day mortality of primary closure at the acute phase. CS (OR = 3.607, 95% CI: 2.301-5.653), NYHA class IV (OR = 6.491, 95% CI: 1.444-29.188) and time to VSD closure were risk predictors for TCC. There was no correlation between defect size (OR = 2.592, 95% CI: 0.380-17.661) and mortality. CONCLUSION TCC should be a relatively safe and minimally invasive method for PIVSD, with an excellent successful device implantation rate and acceptable low 30-day mortality. The procedure appears promising, but its safety and efficacy could only be demonstrated by randomized controlled trials. Therefore, the mortality of data comparing surgery to TCC compels the need for future comparative trials.
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Affiliation(s)
- Xiang Yang
- Department of Obsterics Ultrasound, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650034, China.,Department of Ultrasound Echocardiography, Yanan Hospital of Kunming City, Yunnan Cardiovascular Hospital, Kunming, Yunnan, 650233, China
| | - Zeran Yu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan, Kunming, Yunnan, 650021, China
| | - Yu Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China
| | - Yunchuan Ding
- Department of Ultrasound Echocardiography, Yanan Hospital of Kunming City, Yunnan Cardiovascular Hospital, Kunming, Yunnan, 650233, China
| | - Ruizhi Ni
- Department of Cardiovascular Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China
| | - Pingxi Xiao
- Department of Cardiovascular Medicine, Sir Run Run Hospital Affiliated Nanjing Medical University, Nanjing, Jiangsu, 211166, China
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Alfares F, Sandhu SK. Postinfarction ventricular septal rupture: Transcatheter intervention or surgical repair? J Card Surg 2021; 36:4634-4635. [PMID: 34499380 DOI: 10.1111/jocs.15987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
Postinfarction ventricular septal rupture is an infrequent but potentially fatal complication of acute myocardial infarction. The 30-day mortality rate with the transcatheter approach when performed in the acute phase (<2 weeks) was 25.3% compared to 50% when surgery is performed in the acute phase (within 3 weeks). There is no correlation between defect size and mortality. New York Heart Association class IV and time to ventricular septal defect closure are risk predictors for transcatheter closure for a 30-day mortality rate of 31.5%.
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Affiliation(s)
- Fahad Alfares
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Satinder K Sandhu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
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Petrov IS, Stankov ZI, Boychev DB, Samardjieva M. Endovascular closure of MINOCA-caused ventricular septal defect (VSD). BMJ Case Rep 2021; 14:14/9/e242303. [PMID: 34479879 PMCID: PMC8420730 DOI: 10.1136/bcr-2021-242303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare form of acute myocardial infarction and it is an even rarer cause of ventricular septal defect (VSD). We present a case of successful endovascular closure of post-MINOCA VSD with the use of an atrial septal defect (ASD) occluder. The patient improved from intra-aortic balloon pump dependent to New York Heart Association (NYHA) I in a matter of days. 18-month follow-up period is event free and symptom free.
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Affiliation(s)
- Ivo Spasov Petrov
- Cardiology Department, Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Zoran Iovan Stankov
- Cardiology Department, Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | | | - Martina Samardjieva
- Cardiology Department, Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
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Tendencias temporales en comunicación interventricular posinfarto: resultados del registro CIVIAM. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Okutucu S, Fatihoglu SG, Lacoste MO, Oto A. Echocardiographic assessment in cardiogenic shock. Herz 2020; 46:467-475. [PMID: 33236198 DOI: 10.1007/s00059-020-05000-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022]
Abstract
Echocardiography is the most helpful diagnostic modality in cardiogenic shock, the management of which still remains challenging despite advances in therapeutic options. The presence of cardiogenic shock portends high mortality rates. Therefore, rapid recognition, identification of the underlying cause, and evaluation of the severity of hemodynamic dysfunction are vital for correct management. Whether the cause of shock is unknown, suspected, or established, echocardiography is utilized in its diagnosis and management as well as to monitor progress. It is recommended as the modality of first choice. No other investigative bedside tool can offer comparable diagnostic capability, allowing for exact targeting of the underlying cardiac and hemodynamic problems. Echocardiography can promptly provide an impression of the etiology of shock and the potential line of treatment. Normal left ventricular and right ventricular systolic function, normal cardiac chamber dimensions, absence of any significant valvular pathology, and absence of any pericardial effusion virtually rule out a cardiac cause of shock. This review discusses the role of echocardiography as a decision-making tool in the evaluation and management of cardiogenic shock.
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Affiliation(s)
- Sercan Okutucu
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
| | - Sefik Gorkem Fatihoglu
- Department of Cardiology, Iskenderun State Hospital, P.O: 31300, Hatay, Iskenderun, Turkey.
| | | | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
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31
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Temporal trends in postinfarction ventricular septal rupture: the CIVIAM Registry. ACTA ACUST UNITED AC 2020; 74:757-764. [PMID: 32883644 DOI: 10.1016/j.rec.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Postinfarction ventricular septal rupture is a rare but severe complication of myocardial infarction with high mortality rates. Our goal was to analyze which factors could have an impact on mortality due to this entity over the past decade, including those related to mechanical circulatory support. METHODS The CIVIAM registry is an observational, retrospective, multicenter study carried out in Spain. We designed a comparative analysis, focused on description of in-hospital management and in-hospital and 1-year total mortality as the primary endpoints, dividing the total observation time into 2 equal temporal periods (January 2008 to June2013 and July 2013 to December 2018). RESULTS We included 120 consecutive patients. Total mortality during this period was 61.7% at 1-year follow-up. Patients in the second period were younger. One-year mortality was significantly reduced in the second period (75.6% vs 52.7%, P=.01), and this result was confirmed after adjustment by confounding factors (OR, 0.40; 95%CI, 0.17-0.98). Surgical repair was attempted in 58.7% vs 70.3%, (P=.194), and percutaneous closure in 8.7% and 6.8%, respectively (P=.476). Heart transplant was performed in 1 vs 5 patients (2.2% vs 6.8%, P=.405). The main difference in the clinical management between the 2 periods was the greater use of venoarterial extracorporeal membrane oxygenatiom in the second half of the study period (4.4% vs 27%; P=.001). CONCLUSIONS Postinfarction ventricular septal rupture still carries a very high mortality risk. There has been a progressive trend to increased support with venoarterial extracorporeal membrane oxygenatiom and greater access to available corrective treatments, with higher survival rates.
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32
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Horan DP, O'Malley TJ, Weber MP, Maynes EJ, Choi JH, Patel S, Challapalli J, Luc JGY, Entwistle JW, Todd Massey H, Morris RJ, Tchantchaleishvili V. Repair of ischemic ventricular septal defect with and without coronary artery bypass grafting. J Card Surg 2020; 35:1062-1071. [PMID: 32237166 DOI: 10.1111/jocs.14515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Ventricular septal defect (VSD) following myocardial infarction (MI) is a relatively infrequent complication with high mortality. We sought to investigate the effect of concomitant coronary artery bypass graft (CABG) on outcomes following post-MI VSD repair. METHODS Electronic search was performed to identify all relevant studies published from 2000 to 2018. Sixty-seven studies were selected for the analysis comprising 2174 patients with post-MI VSD. Demographic information, perioperative variables, and outcomes including survival data were extracted and pooled for systematic review and meta-analysis. RESULTS Single-vessel disease was most common (47%, 95% confidence interval [CI], 42-52), left anterior descending coronary artery was the most commonly involved vessel (55%, 95% CI, 46-63), and anterior wall was the most commonly affected territory (57%, 95% CI, 51-63). Concomitant CABG was performed in 52% (95% CI, 46-57) of patients. Of these, infarcted territory was re-vascularized in 54% (95% CI, 23-82). A residual/recurrent shunt was present in 29% (95% CI, 24-34) of patients. Of these, surgical repair was performed in 35% (95% CI, 28-41) and transcatheter repair in 11% (95% CI, 6-21). Thirty-day mortality was 30% (95% CI, 26-35) in patients who had preoperative coronary angiogram, and 58% (95% CI, 43-71) in those who did not (P < .01). No significant survival difference observed between those who had concomitant CABG vs those without CABG. CONCLUSIONS Concomitant CABG did not have a significant effect on survival following VSD repair. Revascularization should be weighed against the risks associated with prolonged cardiopulmonary bypass.
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Affiliation(s)
- Dylan P Horan
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Thomas J O'Malley
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew P Weber
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jae Hwan Choi
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sinal Patel
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jothika Challapalli
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jessica G Y Luc
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John W Entwistle
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - H Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rohinton J Morris
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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A real-world analysis of cardiac rupture on incidence, risk factors and in-hospital outcomes in 4190 ST-elevation myocardial infarction patients from 2004 to 2015. Coron Artery Dis 2020; 31:424-429. [DOI: 10.1097/mca.0000000000000877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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34
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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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Heckle MR, Brooksbank JA, Agarwal MA, Ibebuogu UN. Outcomes of Early Versus Delayed Transcatheter Closure of Post-Myocardial Infarction Ventricular Septal Defect. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1093-1096. [PMID: 32089512 DOI: 10.1016/j.carrev.2020.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Post myocardial infarction ventricular septal defect (VSD) is a rare, but devastating complication which carries a poor prognosis if left untreated. Optimal therapy remains unclear and surgical repair is associated with high mortality. OBJECTIVE The aim of our study is to compare 30-day survival in patients with early versus late primary transcatheter repair of post myocardial infarction ventricular septal defect. METHODS We performed a comprehensive search of published data through SCOPUS and identified published reports of primary transcatheter closure of post myocardial infarction VSD. We included case reports and series that reported timing of VSD closure and 30-day survival and excluded those with prior surgical repair. Early repair was defined as transcatheter closure within 14 days of diagnosis of VSD while late repair was defined as transcatheter closure after 14 days of diagnosis of VSD. RESULTS A total 27 publications describing 193 patients were identified in the SCOPUS search. We excluded 8 publications with no reported timing of VSD repair or 30-day outcome. Of the 193 patients initially included, a total of 126 patients fulfilled all the criteria and were included in the final analysis. The overall 30-day survival rate was found to be 62.7% (79 patients). In the early repair group, only 36.2% of the patients were still alive at 30 days compared to 85.3% in the delayed repair group, P < .01. No significant difference in age, gender, presence of shock, VSD size, presence of significant residual shunt, location of VSD or infarction was observed. The early repair group was found to have a significantly larger Qp: Qs ratio as well as larger occluder size and lower rate of successful repair. CONCLUSION Compared to the late repair group, the early transcatheter VSD repair group had a larger pre-procedure Qp:Qs and worse 30-day survival. Further studies are needed to determine the optimal timing of transcatheter repair of a post myocardial infarction VSD.
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Affiliation(s)
- Mark R Heckle
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Jeremy A Brooksbank
- Department of Medicine, Duke University Medical Center, Durham, NC, United States of America
| | - Manyoo A Agarwal
- Division of Cardiovascular Medicine, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, United States of America
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America.
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Tai S, Tang JJ, Tang L, Ni YQ, Guo Y, Hu XQ, Fang ZF, Pan HW, Huang H, Liu CH, Zeng GF, Zhou SH. Management and Outcome of Ventricular Septal Rupture Complicating Acute Myocardial Infarction: What Is New in the Era of Percutaneous Intervention? Cardiology 2019; 141:226-232. [PMID: 30852569 DOI: 10.1159/000495877] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postinfarction ventricular septal rupture (PI-VSR) is a rare but devastating complication of acute myocardial infarction (AMI). Risk stratification in the acute phase is crucial for decision-making, and this study analyzed the risk factors for early mortality and the effects of various management options on the outcome of PI-VSR patients in the era of percutaneous intervention. METHODS A total of 96 patients with PI-VSR were identified and divided into an acute-phase survivor group (n = 46, survived ≥2 weeks after admission) and a nonsurvivor group (n = 50, died within 2 weeks after admission). Percutaneous closure was considered in acute-phase survivors. Patients were followed up for a mean 47 (quartiles 15-71) months by clinical visit or telephone interview. RESULTS The overall acute-phase (i.e., < 2 weeks after the diagnosis of PI-VSR) mortality rate was 52%. Female sex and Killip Class III-IV at admission were associated with an increased risk of acute-phase death. Of the 46 patients who survived ≥2 weeks, 20 underwent interventional occlusion and the procedure was successful in 19. Percutaneous closure in the acute-phase survivor group improved the immediate (21% in-hospital mortality rate) and long-term (53% mortality) outcomes. CONCLUSIONS Patients with PI-VSR are at a high risk of acute-phase mortality. Female sex and severe cardiac dysfunction at admission are linked with a high rate of acute-phase deaths. Percutaneous closure in acute-phase survivors results in favorable short- and long-term benefits for PI-VSR patients.
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Affiliation(s)
- Shi Tai
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jian-Jun Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liang Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yu-Qing Ni
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanan Guo
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xin-Qun Hu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhen-Fei Fang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hong-Wei Pan
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, China
| | - He Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China
| | - Chang-Hui Liu
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Gao-Feng Zeng
- Department of Cardiology, The Second Affiliated Hospital of University of South China, Hengyang, China
| | - Sheng-Hua Zhou
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China,
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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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Pradhan A, Jain N, Cassese S, Vishwakarma P, Sethi R, Chandra S, Chaudhary G, Dwivedi SK, Narain VS. Incidence and predictors of 30-day mortality in patients with ventricular septal rupture complicating acute myocardial infarction. HEART ASIA 2018; 10:e011062. [PMID: 30166998 DOI: 10.1136/heartasia-2018-011062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 02/05/2023]
Abstract
Objective We sought to investigate the incidence and predictors of 30-day mortality associated with ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) in a cohort of patients admitted to a single centre in India. Methods From October 2013 to February 2016, a total of 6560 patients with a diagnosis of AMI were admitted to our institution. Among these patients, those with a diagnosis of VSR were retrospectively included in this registry. Clinical and echocardiographic features were collected in all cases. The primary outcome was 30-day mortality. A Cox proportional hazard regression analysis explored the predictors of 30-day mortality. Results During the observation period, a total of 51 consecutive patients (mean age 63.8 years (9.1); 51.0% male, 41.2% were patients with diabetes) with a diagnosis of VSR complicating AMI were included. On echocardiography, left ventricular ejection fraction was 42.5% (6.5), and the most frequent location of VSR was apical (78.4%). Overall, 27.4% of the patients received reperfusive therapy (pharmacological, 23.5%; mechanical, 3.9%) and 19.6% of the patients underwent surgical repair. The mean time to surgery was 7.7 days (2.4). At 30-day follow-up, death occurred in 80.4% of patients. Advanced age (HR 1.07, 95% CI (1.02 to 1.13), p=0.004), previous cerebrovascular accident (HR 52.2, 95% CI (3.98 to 685.06), p=0.003) and surgical repair (HR 0.05, 95% CI (0.01 to 0.26), p<0.001) were effect modifiers of the 30-day risk of death. Conclusions In this retrospective cohort of patients with AMI, the occurrence of VSR was not rare and carried a considerable risk of 30-day mortality. Advanced age, previous cerebrovascular accident and surgical repair influenced the risk for 30-day mortality.
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Affiliation(s)
- Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nirdesh Jain
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munchen, Germany
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Gaurav Chaudhary
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - Varun Shankar Narain
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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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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Goldsweig AM, Wang Y, Forrest JK, Cleman MW, Minges KE, Mangi AA, Aronow HD, Krumholz HM, Curtis JP. Ventricular septal rupture complicating acute myocardial infarction: Incidence, treatment, and outcomes among medicare beneficiaries 1999-2014. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27576] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Andrew M. Goldsweig
- Division of Cardiovascular Medicine, Department of Internal Medicine; University of Nebraska Medical Center; Omaha Nebraska
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital; Center for Outcomes Research and Evaluation; New Haven Connecticut
- Department of Biostatistics, Harvard School of Public Health; Boston Massachusetts
| | - John K. Forrest
- Section of Cardiovascular Medicine, Yale University School of Medicine; New Haven Connecticut
| | - Michael W. Cleman
- Section of Cardiovascular Medicine, Yale University School of Medicine; New Haven Connecticut
| | - Karl E. Minges
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital; Center for Outcomes Research and Evaluation; New Haven Connecticut
- Section of Cardiovascular Medicine, Yale University School of Medicine; New Haven Connecticut
| | - Abeel A. Mangi
- Section of Cardiac Surgery, Yale University School of Medicine; New Haven Connecticut
| | - Herbert D. Aronow
- Division of Cardiovascular Medicine; Warren Alpert Medical School of Brown University; Providence Rhode Island
- Lifespan Cardiovascular Institute; Providence Rhode Island
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital; Center for Outcomes Research and Evaluation; New Haven Connecticut
- Section of Cardiovascular Medicine, Yale University School of Medicine; New Haven Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health; New Haven Connecticut
- Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Jeptha P. Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital; Center for Outcomes Research and Evaluation; New Haven Connecticut
- Section of Cardiovascular Medicine, Yale University School of Medicine; New Haven Connecticut
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Aggarwal M, Natarajan K, Vijayakumar M, Chandrasekhar R, Mathew N, Vijan V, Vupputuri A, Chintamani S, Rajendran BK, Thachathodiyl R. Primary transcatheter closure of post-myocardial infarction ventricular septal rupture using amplatzer atrial septal occlusion device: A study from tertiary care in South India. Indian Heart J 2018; 70:519-527. [PMID: 30170647 PMCID: PMC6116725 DOI: 10.1016/j.ihj.2018.01.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/04/2017] [Accepted: 01/25/2018] [Indexed: 11/15/2022] Open
Abstract
Objective The study investigated effectiveness of transcatheter closure of post-myocardial infarction (MI) ventricular septal rupture (VSR) using atrial septal device (ASD) occluder in a cohort of patients admitted at our institute. Method This was a retrospective, observational and single center study, which included patients who were treated with transcatheter closure for post-MI VSR at our tertiary care center between May 2000 and August 2014 depending upon inclusion and exclusion criteria. Primary outcome was all-cause mortality at 30-days follow-up. The MELD-XI (Model for End Stage Liver Disease) score was used as a predictor for poor outcome in these patients. Results A total of 21 patients (mean age 66.4 ± 5.9 years) were included in the study. Study cohort predominantly included male patients (n = 15; 71.4%) and patients with single vessel disease (n = 15; 71.4%). Revascularization of the culprit lesion, before VSR closure, was attempted in 6 patients. Except one patient (treated with Cera® occluder), all patients were treated with Amplatzer® ASD occluders. Average diameter of VSR was 20.8 ± 6.9 mm. Diameter of the device used in the study ranged from 10 mm to 30 mm. Residual defect was detected in 13 patients (62%). All-cause mortality at 30-day follow-up was observed in 9 (42.9%) patients. Time to VSR closure, diameter of VSR, and serum creatinine levels were significantly related to the 30-day mortality. MELD-XI score was found to be strongly associated with increased risk of mortality. Conclusion Primary transcatheter VSR closure using ASD occluders is a feasible approach which can provide reasonable survival outcomes along with equitable mortality rates.
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Affiliation(s)
- Manav Aggarwal
- Former Postgraduate, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham University, Kochi, Kerala, India
| | - Kumaraswamy Natarajan
- Professor of Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham University, Kochi, Kerala, India
| | - Maniyal Vijayakumar
- Professor of Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham University, Kochi, Kerala, India
| | - Rajiv Chandrasekhar
- Professor of Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham University, Kochi, Kerala, India
| | - Navin Mathew
- Professor of Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham University, Kochi, Kerala, India
| | - Vikrant Vijan
- Former Postgraduate, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham University, Kochi, Kerala, India
| | - Anjith Vupputuri
- Former Postgraduate, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham University, Kochi, Kerala, India
| | - Sanjeev Chintamani
- Former Postgraduate, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham University, Kochi, Kerala, India
| | - Bishnu Kiran Rajendran
- Former Postgraduate, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham University, Kochi, Kerala, India
| | - Rajesh Thachathodiyl
- Professor of Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham University, Kochi, Kerala, India.
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Glovaci D, Naqvi A, Yu K, Patel P, Krishnam M. Utility of cardiac MRI in determining percutaneous versus surgical post-infarction ventricular septal defect repair. Future Cardiol 2018; 14:125-130. [PMID: 29355029 DOI: 10.2217/fca-2017-0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Postmyocardial infarction ventricular septal defect (VSD) is a rare complication that can lead to rapid hemodynamic patient decompensation. The type of VSD repair relies on several factors including: size, location, timing and surgical expertise. CASE A 63-year-old man with a ST-elevation myocardial infarction underwent percutaneous coronary intervention of the right coronary artery. A holosystolic murmur was notable postcatheterization, and transthoracic echocardiogram confirmed a VSD. To characterize the VSD, a cardiac MRI demonstrated a large, serpiginous VSD and longitudinal septal tear. Given the anatomic complexity and stable hemodynamics, a surgical trans-left ventricular patch repair was performed. CONCLUSION We emphasize the importance of cardiac magnetic resonance as a decision-making tool, utilizing imaging to ascertain the anatomy combined with hemodynamics to determine optimal individualized therapy.
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Affiliation(s)
- Diana Glovaci
- Department of Internal Medicine, University California Irvine Medical Center, Orange, CA 92868, USA
| | - Ali Naqvi
- Department of Internal Medicine, University California Irvine Medical Center, Orange, CA 92868, USA
| | - Katherine Yu
- Department of Cardiology, University California Irvine Medical Center, Orange, CA 92868, USA
| | - Pranav Patel
- Department of Cardiology, University California Irvine Medical Center, Orange, CA 92868, USA
| | - Mayil Krishnam
- Department of Radiology, University California Irvine Medical Center, Orange, CA 92868, USA
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Goldsweig A, Aronow H. The Evolving Role of Transcatheter Repair of Ventricular Septal Rupture. Cardiology 2018; 141:233-235. [DOI: 10.1159/000496461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022]
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Singh V, Rodriguez AP, Bhatt P, Alfonso CE, Sakhuja R, Palacios IF, Inglessis-Azuaje I, Cohen MG, Elmariah S, O'Neill WW. Ventricular Septal Defect Complicating ST-Elevation Myocardial Infarctions: A Call for Action. Am J Med 2017; 130:863.e1-863.e12. [PMID: 28065768 DOI: 10.1016/j.amjmed.2016.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ventricular septal defect is a lethal complication after an acute myocardial infarction, which has become infrequent with the advent of reperfusion strategies; however, it remains a major contributor to mortality. METHODS We identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes from the Nationwide Inpatient Sample between the years 2001 and 2013. A multivariate hierarchical logistic regression model was used to identify significant predictors of in-hospital mortality. RESULTS We identified 3,373,206 ST-elevation myocardial infarctions, out of which 10,012 (0.3%) were complicated with ventricular septal defects. Most of the patients (60%) were older than 65 years, male (55%), and white (63%). Inferior (49.7%) and anterior (41.1%) myocardial infarctions were more commonly implicated with the development of ventricular septal defects. The median (interquartile range) hospitalization length was 7 (3.0-13.5) days. Only 7.65% of patients underwent some intervention, with 7% surgical and 0.65% minimally invasive. Mechanical support devices were used in 36.5% of patients, with intra-aortic balloon pump (96%) being the most common. In-hospital mortality remained high at 30.5% (downward trending from 41.6% in 2001 to 23.3% in 2013). Age, cardiogenic shock, and in-hospital cardiac arrest were statistically significant predictors of in-hospital mortality. The utilization of corrective procedures significantly declined. The use of mechanical support devices and performing a corrective procedure were associated with higher mortality, length of stay, and cost. CONCLUSIONS Ventricular septal defects after acute myocardial infarctions remain associated with significantly high mortality rates. Highly specialized regional centers with individual expertise in the management of septal ruptures are required to improve outcomes of these patients.
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Affiliation(s)
- Vikas Singh
- Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston.
| | - Alex P Rodriguez
- Cardiovascular Division, University of Miami, Miller School of Medicine, Fla
| | - Parth Bhatt
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock
| | - Carlos E Alfonso
- Cardiovascular Division, University of Miami, Miller School of Medicine, Fla
| | - Rahul Sakhuja
- Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Igor F Palacios
- Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ignacio Inglessis-Azuaje
- Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Mauricio G Cohen
- Cardiovascular Division, University of Miami, Miller School of Medicine, Fla
| | - Sammy Elmariah
- Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
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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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Sabiniewicz R, Huczek Z, Zbroński K, Scisło P, Rymuza B, Kochman J, Marć M, Grygier M, Araszkiewicz A, Dziarmaga M, Leśniewicz P, Hiczkiewicz J, Kidawa M, Filipiak KJ, Opolski G. Percutaneous Closure of Post-Infarction Ventricular Septal Defects-An Over Decade-long Experience. J Interv Cardiol 2017; 30:63-71. [PMID: 28078714 DOI: 10.1111/joic.12367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To report an over decade-long experience with percutaneous post-infarction ventricular septal defect (PIVSD) closure. BACKGROUND PIVSDs remains a major clinical challenge with extremely high mortality. Data concerning interventional closure of PIVSD is scarce. METHODS All percutaneous PIVSD closures performed between 2003 and 2016 in 8 participating centres were identified. Data concerning patients and procedures was acquired. Patients were divided into two groups, based on the time interval between VSD diagnosis and closure (≤14 days-acute phase, >14 days-non-acute phase). RESULTS Twenty-one percutaneous PIVSD closures were performed on 20 patients (9 females, mean age: 70 years). Mean interval between the diagnosis and the procedure was 182.6 ± 500 days (range: 7-2228). Defects were mostly located in apical (55%) segments of the septum. In 7 cases (33%) the procedure was performed in the acute phase. The closure was technically successful in 17 cases (81%). Four patients died within 48 hours after the procedure. 30-days survival rate of the entire cohort was 70%. Univariate analysis revealed impact of technical success of the procedure (HR 0.13, CI 0.03-0.68 P = 0.016) and white blood cell count (HR 1.36 per unit increase, CI 1.1-1.69, P = 0.005) on 30-day mortality. CONCLUSIONS In a selected population of patients percutaneous PIVSD closure is feasible and provides satisfactory survival rate. Procedural success has a protective impact on survival. Timing of the closure remains controversial. Procedure in the non-acute phase carries lower mortality, but at the same time introduces a selection bias. Larger registry-based studies are required.
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Affiliation(s)
- Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdańsk, Poland
| | - Zenon Huczek
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Karol Zbroński
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Scisło
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Rymuza
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Miłosz Marć
- Department of Cardiology with Subunit for Acute Coronary Syndromes, Clinical Hospital no. 2, Rzeszów, Poland
| | - Marek Grygier
- First Department of Cardiology, Medical University of Poznań, Poznań, Poland
| | | | - Mieczysław Dziarmaga
- Central Laboratory of Endovascular Diagnostics of Cardiovascular Diseases, Clinical Hospital, Poznań, Poland
| | - Piotr Leśniewicz
- Department of Cardiology and Invasive Cardiology, Public Hospital, Szczecin, Poland
| | | | - Michał Kidawa
- Department of Cardiology, Medical University of Łódź, Łódź, Poland
| | | | - Grzegorz Opolski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Ventricular Septal Defect from Takotsubo Syndrome. Case Rep Cardiol 2016; 2016:2693062. [PMID: 27563471 PMCID: PMC4987479 DOI: 10.1155/2016/2693062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/25/2016] [Accepted: 07/10/2016] [Indexed: 11/17/2022] Open
Abstract
Takotsubo Syndrome is a transient condition characterized by left ventricular systolic dysfunction with apical akinesis/dyskinesis and ballooning. Although the prognosis with medical management is excellent in most cases, rare cases of serious complications can occur. We present here a case of a 71-year-old woman presenting with acute decompensated heart failure with initial findings consistent with a myocardial infarction, who was found instead to have an acute ventricular septal defect as a complication of Takotsubo Syndrome.
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Wilson WM, Horlick EM. Management of post-myocardial infarction ventricular septal rupture. EUROINTERVENTION 2016; 12 Suppl X:X18-X23. [DOI: 10.4244/eijv12sxa4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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50
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Iyer S, Bauer T, Yeung M, Ramm C, Kiser AC, Caranasos TG, Vavalle JP. A heart team and multi-modality imaging approach to percutaneous closure of a post-myocardial infarction ventricular septal defect. Cardiovasc Diagn Ther 2016; 6:180-4. [PMID: 27054108 DOI: 10.21037/cdt.2015.10.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Post-infarction ventricular septal defect (PI-VSD) is a devastating complication that carries a high mortality with or without surgical repair. Percutaneous closure is an attractive alternative in select patients though requires appropriate characterization of the PI-VSD as well as careful device and patient selection. We describe a multidisciplinary and multi-modality imaging approach to successful percutaneous closure of a PI-VSD.
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Affiliation(s)
- Sunil Iyer
- Departments of Cardiothoracic Surgery and Cardiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Thurston Bauer
- Departments of Cardiothoracic Surgery and Cardiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Michael Yeung
- Departments of Cardiothoracic Surgery and Cardiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Cassandra Ramm
- Departments of Cardiothoracic Surgery and Cardiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Andy C Kiser
- Departments of Cardiothoracic Surgery and Cardiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Thomas G Caranasos
- Departments of Cardiothoracic Surgery and Cardiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - John P Vavalle
- Departments of Cardiothoracic Surgery and Cardiology, University of North Carolina, Chapel Hill, NC 27599, USA
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