Original article
Adult cardiac
Ventricular Septal Rupture Complicating Acute Myocardial Infarction: Clinical Characteristics and Contemporary Outcome

https://doi.org/10.1016/j.athoracsur.2008.01.010Get rights and content

Background

The objective of this paper was to study the patient characteristics and contemporary short- and long-term outcome in patients with postinfarct ventricular septal rupture.

Methods

Based on patient files and register data we performed a review of 64 consecutive patients with ventricular septal rupture complicating acute myocardial infarction, admitted to our tertiary center.

Results

The mean age of the patients was 70 ± 7. The median time was five days from onset of symptoms to the diagnosis of the ventricular septal rupture. The overall 30-day, one-, and five- year mortalities were 62%, 72%, and 95%, respectively. Medical treated patients (n = 19) had a 30-day mortality of 100%. Among surgically treated patients (n = 45) the survival at one month, one and five years was 71%, 48%, and 32%, respectively. History of hypertension, complicating congestive heart failure, and age were associated with poor outcome.

Conclusions

Despite improvements in medical and interventional techniques the early as well as the long-term prognosis remains poor in this contemporary series.

Section snippets

Patients and Methods

We reviewed the medical records of 64 consecutive patients admitted to our tertiary cardiac center with ventricular septal rupture complicating AMI during the period from January 1993 to December 2002. Data were collected retrospectively. Individual consent for participation was therefore not obtained. This approach was approved by the local ethical committee. The diagnosis of AMI was based on typical clinical symptoms, electrocardiographic signs of infarction, and a documented elevation of

Clinical Characteristics

Table 1 displays the baseline characteristics for the 64 patients. Median time from debut of AMI symptoms to diagnosis of the ventricular septal rupture was five days (range, 0 to 195 days). Twenty-seven percent and 64% of the cases were diagnosed within two days, respectively, one week after the reported onset of AMI symptoms (Fig 1).

Based on electrocardiographic (ECG) findings, the index myocardial infarction was inferior in 29 patients, anterior in 30 patients, and combined anterior and

Comment

In a relatively large consecutive and contemporary series of patients with AMI complicated with ventricular septal rupture, the present study demonstrates that the overall short- and long-term mortality remains high in the reperfusion era. It is notable that, due to the Danish socialized medicine practice, this material represents unselected patients from a defined geographic area within a defined time period.

References (28)

  • M.C. Fishbein et al.

    The histopathologic evolution of myocardial infarction

    Chest

    (1978)
  • T.E. David et al.

    Postinfarction ventricular septal rupture: repair by endocardial patch with infarct exclusion

    J Thorac Cardiovasc Surg

    (1995)
  • C. Faber et al.

    Implantable left ventricular assist device for patients with postinfarction ventricular septal defect

    J Thorac Cardiovasc Surg

    (2002)
  • D.D. Muehrcke et al.

    Postinfarct ventricular septal defect repair: effect of coronary artery bypass grafting

    Ann Thorac Surg

    (1992)

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    Copyright © 2008 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.