Cierre percutáneo de comunicaciones interventriculares postinfarto mediante los dispositivos de Amplatzer

doi:10.1016/S0300-8932(07)75074-1

Revista Española de Cardiología

Volume 60, Issue 5, May 2007, Pages 548-551

https://doi.org/10.1016/S0300-8932(07)75074-1 Get rights and content

Se intentó el cierre percutáneo de la comunicación interventricular postinfarto (CIVPI) en 19 pacientes: 2 con recanalización tras el cierre quirúrgico y 17 con CIVPI primaria. En estos últimos, el procedimiento se realizó en 3 pacientes con CIVPI aguda dentro de las primeras 3 semanas postinfarto, en 13 con CIVPI subaguda 3,5-12 semanas postinfarto y en uno con CIVPI crónica. Se llevaron a cabo 22 intervenciones mediante la utilización de 17 oclusores Amplatzer auriculares, 2 ventriculares postinfarto y 2 ventriculares musculares. El procedimiento fue satisfactorio en 14 pacientes: 11 con CIVPI subaguda, uno con CIVPI crónica y 2 posquirúrgicos. El cierre percutáneo de CIVPI con el Amplatzer Atrial Occlusor es probablemente el tratamiento de elección en pacientes con más de 3,5 semanas después del infarto de miocardio y en casos con recanalización tras el cierre quirúrgico.

We carried out transcatheter procedures to close postinfarction ventricular septal defects (PIVSDs) in 19 patients: two had recanalization after surgical closure, and 17 had a primary PIVSD. In three of the latter patients, who had acute PIVSDs, the procedure was carried out in the first 3 weeks after infarction; in the 13 patients with subacute PIVSD, it was carried out 3.5-12 weeks after infarction. There was another procedure in one patient with chronic PIVSD. In total, 22 procedures were completed: 17 using an Amplatzer atrial septal occluder, two using an Amplatzer postinfarction ventricular septal defect occluder, and two using an Amplatzer muscular ventricular septal defect occluder. The procedure was successful in 14 patients: in 11 with subacute PIVSD, one with chronic PIVSD, and two with postsurgical PIVSD. Transcatheter closure of PIVSDs using an Amplatzer atrial septal occluder is probably the treatment of choice in patients undergoing surgery more than 3.5 weeks after myocardial infarction and in those with recanalization after previous surgical closure.

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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
2024, International Journal of Cardiology
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.
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.
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.
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.
Post-Myocardial Infarction Ventricular Septal Defect: A Comprehensive Review
2020, Cardiovascular Revascularization Medicine
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Patients were managed for 3.5 to 12 weeks post-intervention. The authors of this study concluded that patients who were managed in the chronic phase (>3 weeks) had a better mortality rate as compared to earlier intervention [31]. Assenza et al. also conducted a prospective cohort study of 12 patients using a variety of devices including Clamshell, CardioSEAL, and Starflex (NMT Medical, Inc., Boston, Massachusetts).
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.
Outcomes of Early Versus Delayed Transcatheter Closure of Post-Myocardial Infarction Ventricular Septal Defect
2020, Cardiovascular Revascularization Medicine
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Five patients ended up requiring surgical intervention after device placement. Another cohort of 17 patients with primary post-MI VSD studied by Bialkowski et al. [14] aged between 53 and 81 years had a survival rate of 65%. Patients managed in the post-acute phase, defined as >3 weeks in their study, had a better mortality rate as compared to earlier intervention.
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.
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.
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.
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.
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.
Ventricular septal rupture: A rare post-myocardial infarction complication with a very high mortality rate
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Transcatheter approach using the post-MI Amplatzer Ventricular Septal Defect device represents an attractive and less invasive option for selected cases [5,6]. The transcatheter approach provides either initial hemodynamic stabilization by reducing the left-to-right shunt (bridge to surgery) [7,8] or definitive treatment, but experience with this approach is still limited, and residual shunts are common [5–14]. Furthermore early intervention, in particular for those presenting with cardiogenic shock is also associated with a high mortality rate.
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Comunicación BreveCierre percutáneo de comunicaciones interventriculares postinfarto mediante los dispositivos de AmplatzerTranscatheter Closure of Postinfarction Ventricular Septal Defects Using Amplatzer Devices

Rev Esp Cardiol

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Comunicación Breve
Cierre percutáneo de comunicaciones interventriculares postinfarto mediante los dispositivos de AmplatzerTranscatheter Closure of Postinfarction Ventricular Septal Defects Using Amplatzer Devices