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Plugging the Hole: Diagnosis and Management of Post–Myocardial Infarction Ventricular Septal Defect

ABSTRACT: Graphical abstract Highlights • VSD after MI is a rare and often fatal complication.• Echocardiography is essential in the diagnosis and management of these patients.• Though urgent surgical repair is recommended, operative risk is often high.• VA ECMO and percutaneous closure under echocardiographic guidance are alternatives.• Echocardiography can identify persistent AV closure and stasis in the aortic root.

SUBMITTER: Sharma E

PROVIDER: S-EPMC7451908 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Project description:BackgroundVentricular septal rupture (VSR) is a rare complication after acute myocardial infarction (AMI) especially in the reperfusion era but its associated mortality has remained high. This case series evaluated in-hospital and intermediate-term mortality in VSR patients. Additionally, we also analyzed risk factors, clinical presentation, intervention, and predictors of in-hospital mortality in VSR patients.MethodsData of 67 patients with echocardiography confirmed diagnosis of VSR from January 2011 to April 2020 was extracted from hospital medical records. Records were also reviewed to document 30 day and 1-year mortality, recurrent heart failure admission, repeat myocardial infarction, and revascularization. In addition, telephonic follow-up was done to assess health-related quality of life(HRQOL) assessed by KCCQ-12. SCAI shock classification was used to categorize severity of cardiogenic shock. Univariate and multivariable logistic regression was used to determine predictors of in-hospital mortality. Survival function was presented using the Kaplan-Meier survival curve.ResultsMean age of patients was 62.7 ± 11.1 years, 62.7% were males. 65.7% of the patients presented more than 24 hours after MI and did not receive reperfusion therapy. Median time from AMI to VSR diagnosis was 2 (1-5) days. VSR closure was attempted in 53.7% patients. In-hospital mortality was 65.7%. At univariate level, predictors of in-hospital mortality were non-surgical management, basal VSR, right ventricular dysfunction, early VSR post-MI, and severe cardiogenic shock at admission (class C, D, or E). Adjusted predictors of in-hospital mortality included non-surgical management, basal VSR and advanced cardiogenic shock. There were 5 deaths during median followup of 44.1 months. HRQOL in patients available on followup was good (54.5%) or excellent (45.5%).ConclusionHigh in-hospital mortality was seen in VSR patients. VSR closure is the preferred treatment to get long-term survival, however, timing of repair as well as severity of cardiogenic shock plays a significant role in determining prognosis.

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Plugging the Hole: Diagnosis and Management of Post–Myocardial Infarction Ventricular Septal Defect

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