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Hiltner E, Sandhaus M, Awasthi A, Hakeem A, Kassotis J, Takebe M, Russo M, Sethi A. Trends in the incidence, mortality and clinical outcomes in patients with ventricular septal rupture following an ST-elevation myocardial infarction. Coron Artery Dis 2024:00019501-990000000-00243. [PMID: 38861159 DOI: 10.1097/mca.0000000000001401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
BACKGROUND Despite improvements in outcomes of ST elevation myocardial infarction (STEMI), ventricular septal rupture (VSR) remains a known complication, carrying high mortality. The contemporary incidence, mortality, and management of post-STEMI VSR remains unclear. METHODS The National Inpatient Sample database (2009-2020) was used to study trends in admissions and outcomes of post-STEMI VSR over time. Survey estimation commands were used to determine weighted national estimates. RESULTS There were 2 315 186 ± 22 888 visits for STEMI with 0.194 ± 0.01% experiencing VSR during 2009-2020 in the USA. Patients with VSR were more often older, white, female, and presented with an anterior STEMI; there was no difference in the rates of fibrinolysis. In-hospital mortality was 73.6 ± 1.8%, but only 29.2 ± 1.9 and 10 ± 1.2% received surgical repair and transcatheter repair (TCR), respectively. TCR was associated with higher and surgical repair with lower mortality. Days to surgery were longer for those who survived (5.9 ± 2.75) compared with those who died (2.44 ± 1). In a multivariable analysis, surgical repair at greater than or equal to day 4 was associated with lower in-hospital mortality (odds ratio = 0.39, 95% confidence interval: 0.17-0.88). CONCLUSION Mortality in post-STEMI VSR remains high with no improvement over time. Most patients are managed conservatively, and the frequency of surgical repair has decreased, while TCR has increased over the study period. Despite design limitations and survival bias, surgical repair at greater than or equal to 4 days was associated with a lower mortality.
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Affiliation(s)
- Emily Hiltner
- Division of Cardiology, Department of Medicine
- Division of Cardiac Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Marc Sandhaus
- Division of Cardiology, Department of Medicine
- Division of Cardiac Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Ashish Awasthi
- Division of Cardiology, Department of Medicine
- Division of Cardiac Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Abdul Hakeem
- Division of Cardiology, Department of Medicine
- Division of Cardiac Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - John Kassotis
- Division of Cardiology, Department of Medicine
- Division of Cardiac Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Manabu Takebe
- Division of Cardiac Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Mark Russo
- Division of Cardiac Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Ankur Sethi
- Division of Cardiology, Department of Medicine
- Division of Cardiac Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
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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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3
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Ning F, Liu H, Yan Y. Clinical characteristics, prognostic factors, and outcomes of ventricular septal rupture in patients with acute myocardial infarction. J Investig Med 2023; 71:361-371. [PMID: 36692151 DOI: 10.1177/10815589221149185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ventricular septal rupture (VSR) is a rare but devastating complication in patients with acute myocardial infarction (AMI). This was a retrospective single-center observational study which aimed to assess the characteristics and outcomes of VSR patients and identify risk factors for in-hospital mortality of VSR patients in the era of percutaneous intervention. Patients with VSR after AMI at the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to December 2020 were enrolled. Among 5395 consecutive patients with AMI, 42 patients (0.78%) were diagnosed with VSR. Left anterior descending coronary artery was the culprit vessel in most cases (84.4%, 27/32). In the multivariate analysis, female sex (odds ratio (OR): 14.043, 95% confidence interval (CI): 1.396-141.283, p = 0.025) and lower platelet count on admission (OR: 0.979; 95% CI: 0.963-0.995; p = 0.009) were significant risk factors of in-hospital death in VSR patients. In all, 11 patients (26.2%) underwent surgical repair, and the rest were treated medically. The 1-year mortality was lower in the surgical group (36.4%, 4/11) than that in the conservative group (74.2%, 23/31) (p = 0.034). During the follow-up, VSR patients treated surgically tended to have a higher long-term survival rate than those treated medically (log rank χ2 = 5.005, p = 0.025). The prognosis of patients with VSR remained poor in this study. Female sex and lower platelet count were independent risk factors of in-hospital death in VSR patients. The long-term survival rate of patients treated with surgical repair was significantly better than that of patients treated conservatively.
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Affiliation(s)
- Feifei Ning
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, P.R. China
| | - Hui Liu
- The Biobank of the First Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi Province, P.R. China
| | - Yang Yan
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, P.R. China
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4
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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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5
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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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Hahn RT, Saric M, Faletra FF, Garg R, Gillam LD, Horton K, Khalique OK, Little SH, Mackensen GB, Oh J, Quader N, Safi L, Scalia GM, Lang RM. Recommended Standards for the Performance of Transesophageal Echocardiographic Screening for Structural Heart Intervention: From the American Society of Echocardiography. J Am Soc Echocardiogr 2022; 35:1-76. [PMID: 34280494 DOI: 10.1016/j.echo.2021.07.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rebecca T Hahn
- Columbia University Irving College of Medicine, New York, New York
| | - Muhamed Saric
- New York University Langone Health, New York, New York
| | | | - Ruchira Garg
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Omar K Khalique
- Columbia University Irving College of Medicine, New York, New York
| | - Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | - Jae Oh
- Mayo Clinic, Rochester, Minnesota
| | | | - Lucy Safi
- Hackensack University Medical Center, Hackensack, New Jersey
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7
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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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8
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Zhong W, Liu Z, Wang X, Huang C, Zhong Z. Retrograde transcatheter closure of ventricular septal perforation after acute myocardial infarction: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:769. [PMID: 32647694 PMCID: PMC7333127 DOI: 10.21037/atm-20-4014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The use of the Lunderquist exchange guide wire via the retrograde approach of the right femoral vein-inferior vena cava-right atrium-right ventricle-ventricular septal perforation-left ventricle-descending aorta can maintain guide wire tension and significantly reduce the operative time. The patient was admitted due to chest pain for 3 hours. The diagnosis was acute anterior septal myocardial infarction with ventricular septal perforation. One week after admission, a drug-eluting stent was implanted in the left anterior descending branch. Repeated echocardiography revealed that the diameter of the ventricular septal perforation had increased from 6 to 12 mm. During this period, the patient suffered from repeated episodes of shortness of breath that were progressively exacerbated. The patient was transferred to the intensive care unit (ICU) and underwent intra-aortic balloon pump (IABP) implantation. Twenty days after admission, the Lunderquist exchange guide wire was used via the retrograde approach of the right femoral vein-inferior vena cava-right atrium-right ventricle-ventricular septal perforation-left ventricle-descending aorta. A 26-mm occluder was released for transcatheter closure of the ventricular septal perforation. Shortness of breath was immediately relieved. The patient was discharged 3 days later. Retrograde transcatheter closure of ventricular septal perforation can effectively reduce operative time and is conducive to quick and stable improvement of the patient’s condition.
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Affiliation(s)
- Wei Zhong
- Center for Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital, Meizhou Hospital Affiliated to Sun Yat-sen University), Meizhou, China
| | - Zhidong Liu
- Center for Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital, Meizhou Hospital Affiliated to Sun Yat-sen University), Meizhou, China
| | - Xianfang Wang
- Center for Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital, Meizhou Hospital Affiliated to Sun Yat-sen University), Meizhou, China
| | - Changjing Huang
- Center for Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital, Meizhou Hospital Affiliated to Sun Yat-sen University), Meizhou, China
| | - Zhixiong Zhong
- Center for Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital, Meizhou Hospital Affiliated to Sun Yat-sen University), Meizhou, China
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9
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Abstract
Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Bradley Ternus
- Division of Cardiovascular Medicine, 5228University of Wisconsin, Madison, WI, USA
| | - Mackram Eleid
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA
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10
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Mukherjee A, Fong J. Heartbreak: A case of post-infarction cardiogenic shock. Australas J Ultrasound Med 2019; 22:66-71. [PMID: 34760540 PMCID: PMC8411691 DOI: 10.1002/ajum.12123] [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: 11/10/2022] Open
Abstract
Ventricular septal rupture is a rare but catastrophic complication of acute myocardial infarction. Although it has declined in incidence since the introduction of percutaneous coronary intervention, there hasn't been a significant change of mortality from the condition. In the chain of survival, prompt diagnosis and definitive surgery form the cardinal links. Prolonged medical management is not a feasible option as it is likely to be futile but the aim should be to reduce afterload with the help of intra-aortic balloon pump or support with ventricular assist devices. Echocardiography sits at the heart of the diagnosis of this time critical condition and will guide accurate therapy and intervention. We present the first reported case from an Australian emergency department, where the echocardiography done by the emergency physician clinched the diagnosis. We emphasise here the paramountcy of emergency physicians being proficient in basic echocardiography to achieve rapid diagnosis. Once diagnosed it is critical to have an individual case-tailored multi-disciplinary discussion between emergency medicine, cardiothoracic surgery, cardiology and intensive care as to plan the optimal timing of surgery.
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Affiliation(s)
- Ashes Mukherjee
- Department of Emergency MedicineArmadale HospitalArmadaleWestern AustraliaAustralia
| | - Jason Fong
- Department of Emergency MedicineArmadale HospitalArmadaleWestern AustraliaAustralia
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11
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Sari M, Kahveci G, Kilicgedik A, Ayturk M, Pala S. Acute myocardial infarction complicated with ventricular septal rupture and intracranial hemorrhage. Echocardiography 2018; 35:559-562. [PMID: 29420842 DOI: 10.1111/echo.13824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction (AMI) with an associated mortality that ranges from 41% to 80%. The treatment consists of supplemental oxygenation, afterload reduction, intraaortic balloon pump, and surgical repair. In selected patients, extracorporeal membrane oxygenation (ECMO) and/or percutaneous closure of the defect can be considered if anatomically appropriate. Echocardiography evaluates the morphology and location of the defect, anatomical concerns for percutaneous closure, and accompanying pathologies. We present a 48-year-old man with inferior myocardial infarction and basal VSR who was not a candidate for percutaneous closure. Surgery was planned, but he died from extensive subarachnoid and intracranial hemorrhage.
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Affiliation(s)
- Munevver Sari
- Cardiology Department, University of Health Sciences, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Gokhan Kahveci
- Cardiology Department, University of Health Sciences, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Alev Kilicgedik
- Cardiology Department, University of Health Sciences, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Ayturk
- Cardiology Department, University of Health Sciences, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Selcuk Pala
- Cardiology Department, University of Health Sciences, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
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12
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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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