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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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Yousef S, Sultan I, VonVille HM, Kahru K, Arnaoutakis GJ. Surgical management for mechanical complications of acute myocardial infarction: a systematic review of long-term outcomes. Ann Cardiothorac Surg 2022; 11:239-251. [PMID: 35733723 PMCID: PMC9207694 DOI: 10.21037/acs-2021-ami-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/12/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Mechanical complications following acute myocardial infarction (AMI), though rare, are associated with significant morbidity and mortality. Surgical management remains a mainstay of therapy for these complications. The purpose of this review is to evaluate long-term outcomes data of surgical management for postinfarction free wall rupture, ventricular septal defect, papillary muscle rupture, and pseudoaneurysm. METHODS An electronic literature search was performed to identify original studies reporting long-term outcomes data of surgical management of one of the four mechanical complications following AMI. Studies were considered to have long-term outcomes if they at minimum included survival or mortality data up to one year. RESULTS A total of 285 studies were identified from the literature search. Of these, 29 studies with long-term survival data on surgically managed mechanical complications of AMI are included in the review. The majority of these are retrospective cohort studies or single-center case series. Five studies are included on free wall rupture, 18 on ventricular septal defect, 4 on papillary muscle rupture, and 2 on pseudoaneurysm. Detailed results are tabulated according to complication. CONCLUSIONS Long-term surgical outcomes of postinfarction mechanical complications remain understudied. Outcomes for ventricular septal defect repair are better represented in the literature than are outcomes for other mechanical complications, though available studies are still limited by small sample sizes and retrospective design. Further research is warranted, particularly for outcomes of acute pseudoaneurysm repair.
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Affiliation(s)
- Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Helena M VonVille
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin Kahru
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Khazi FM, Al-Safadi F, Karaly Y, Siddiqui NR, Al-Zamkan B, Aljassim O. Management issues during postinfarction ventricular septal defect and role of perioperative optimization: A case series. Ann Card Anaesth 2020; 22:30-34. [PMID: 30648676 PMCID: PMC6350439 DOI: 10.4103/aca.aca_189_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The development of a myocardial infarction ventricular septal rupture is a rare fatal complication, and the surgical repair is the treatment of choice. In most of the scenarios, the operation will be done as an emergency procedure that carries high mortality. Prognosis of these patients depends on prompt echocardiographic diagnosis and the proactive medical and surgical therapy. More recently, various options have been put forward including the timing for surgery, percutaneous closure devices, and the improved outcome with initial stabilization with medical treatment including mechanical support. In this retrospective case series, we are presenting the management of these patients who presented us in different clinical scenarios and trying to identify the risks for the poor outcome and to formulate a strategy to improve the outcome.
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Affiliation(s)
- Fayaz Mohammed Khazi
- Department of Cardiothoracic Surgery, Dubai Hospital, Al Baraha, Dubai, United Arab Emeritus
| | - Faozi Al-Safadi
- Department of Cardiothoracic Surgery, Dubai Hospital, Al Baraha, Dubai, United Arab Emeritus
| | - Yehia Karaly
- Department of Cardiothoracic Surgery, Dubai Hospital, Al Baraha, Dubai, United Arab Emeritus
| | - Nayyer R Siddiqui
- Department of Cardiothoracic Surgery, Dubai Hospital, Al Baraha, Dubai, United Arab Emeritus
| | - Bassil Al-Zamkan
- Department of Cardiothoracic Surgery, Dubai Hospital, Al Baraha, Dubai, United Arab Emeritus
| | - Obaid Aljassim
- Department of Cardiothoracic Surgery, Dubai Hospital, Al Baraha, Dubai, United Arab Emeritus
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Jacob S, Patel MJ, Lima B, Felius J, Malyala RS, Chamogeorgakis T, MacHannaford JC, Gonzalez-Stawinski GV, Rafael AE. Using extracorporeal membrane oxygenation support preoperatively and postoperatively as a successful bridge to recovery in a patient with a large infarct-induced ventricular septal defect. Proc (Bayl Univ Med Cent) 2016; 29:301-4. [PMID: 27365878 DOI: 10.1080/08998280.2016.11929443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Rupture of the ventricular septum during acute myocardial infarction usually occurs within the first week. The event is usually followed by low cardiac output, heart failure, and multiorgan failure. Despite the many advances in the nonoperative treatment of heart failure and cardiogenic shock, including the intra-aortic balloon pump and a multitude of new inotropic agents and vasodilators, these do not supplant the need for operative intervention in these critically ill patients. This article describes the successful use of extracorporeal membrane oxygenation support as a bridge to recovery postoperatively in a patient with a large infarct-produced ventricular septal defect.
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Affiliation(s)
- Samuel Jacob
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Mitesh J Patel
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Brian Lima
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Joost Felius
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Rajasekhar S Malyala
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Themistokles Chamogeorgakis
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Juan C MacHannaford
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Gonzalo V Gonzalez-Stawinski
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Aldo E Rafael
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
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