Original articleAdult cardiacPostinfarction Ventricular Septal Defects: Towards a New Treatment Algorithm?
Section snippets
Patient Selection
Between May 1995 and November 2007, 51 patients with a diagnosis of postinfarction VSD were treated at the Montreal Heart Institute. Of these, 39 patients underwent operations, and 12 were considered for primary or residual percutaneous closure. The protocol was reviewed and approved by the Montreal Heart Institute Research Center Ethical Committee. Written informed consent was obtained from all patients.
A preoperative transthoracic echocardiography study was done in all patients. Patients were
Patient Characteristics and Hemodynamic Data
Characteristics for the 51 patients (66% men) in the study are presented in Table 1. Mean age was 68 ± 9 years old. A history of coronary artery disease was present in 16%. Standard comorbidities were hypertension in 52%, diabetes mellitus in 18%, hypercholesterolemia in 38%, obesity (body mass index > 35 kg/m2) in 12%, active smoking in 54%, and family history of coronary artery disease in 33%. In this group, 12 patients (23%) underwent percutaneous closure of a post-MI VSD. From this group, 2
Comment
This retrospective analysis study described the experience of the Montreal Heart Institute with a rare but lethal complication after acute MI. The primary objective was to perform a descriptive analysis of our population and identify significant predictors of hospital or 30-day mortality. We reported our experience with the percutaneous treatment of postinfarction VSD using the Amplatzer occluder device. Early in-hospital mortality for the overall group was 33%, and the mean hospital length of
References (20)
- et al.
Ventricular septal and free wall rupture complicating acute myocardial infarction: experience in the Multicenter Investigation of Limitation of Infarct Size
Am Heart J
(1989) - et al.
Frequency of collateral blood flow in the infarct-related coronary artery in rupture of the ventricular septum after acute myocardial infarction
Am J Cardiol
(2000) - et al.
Ventricular septal rupture complicating acute myocardial infarction: identification of simple and complex in 53 autopsied hearts
Am J Cardiol
(1984) - et al.
Prognosis in rupture of the ventricular septum after acute myocardial infarction and role of early surgical intervention
Am J Cardiol
(1992) - et al.
Acute postinfarction septal rupture: long-term results
Ann Thorac Surg
(1991) - et al.
Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry
J Am Coll Cardiol
(2000) - et al.
Surgical management of postinfarction ventricular septal rupture
Ann Thorac Surg
(1986) - et al.
Late functional results after surgical closure of acquired ventricular septal defect
J Thorac Cardiovasc Surg
(1993) - et al.
Operative results of “repair” of ventricular septal rupture after acute myocardial infarction
Am J Cardiol
(1999) - et al.
1999 Update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction)
J Am Coll Cardiol
(1999)