Original article
Adult cardiac
Postinfarction Ventricular Septal Defects: Towards a New Treatment Algorithm?

https://doi.org/10.1016/j.athoracsur.2008.11.052Get rights and content

Background

We reviewed our experience at the Montreal Heart Institute with early surgical and percutaneous closure of postinfarction ventricular septal defects (VSD).

Methods

Between May 1995 and November 2007, 51 patients with postinfarction VSD were treated. Thirty-nine patients underwent operations, and 12 were treated with percutaneous closure of the VSD.

Results

Half of the patients were in systemic shock, and 88% were supported with an intraaortic balloon pump before the procedure. Before the procedure, 14% of patients underwent primary percutaneous transluminal coronary angioplasty. The mean left ventricular ejection fraction was 0.44 ± 0.11, and mean Qp/Qs was 2.3 ± 1. Time from acute myocardial infarction to VSD diagnosis was 5.4 ± 5.1 days, and the mean delay from VSD diagnosis to treatment was 4.0 ± 4.0 days. A moderate to large residual VSD was present in 10% of patients after correction. Early overall mortality was 33%. Residual VSD, time from myocardial infarction to VSD diagnosis, and time from VSD diagnosis to treatment were the strongest predictor of mortality. Twelve patients were treated with a percutaneous occluder device, and the hospital or 30-day mortality in this group was 42%.

Conclusion

Small or medium VSDs can be treated definitively with a ventricular septal occluder or initially to stabilize patients and allow myocardial fibrosis, thus facilitating delayed subsequent surgical correction.

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

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