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Transcatheter Closure of Postinfarction Ventricular Septal Defect: A Case Report and Review of Literature.

Shabestari MM, Ghaderi F, Hamedanchi A - J Cardiovasc Thorac Res (2015)

Bottom Line: Ventricular septal rupture (VSR) is an uncommon but serious complication of acute myocardial infarction (MI), associated with a high mortality rate.Although early surgical treatment improves the prognosis, hospital mortality after emergency surgery remains high.Herein, we report a case of acute post-MI VSR that was successfully closed using an Amplatzer postinfarction muscular ventricular septal defect (PIMVSD) occluder device with good immediate and long-term outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT
Ventricular septal rupture (VSR) is an uncommon but serious complication of acute myocardial infarction (MI), associated with a high mortality rate. Although early surgical treatment improves the prognosis, hospital mortality after emergency surgery remains high. Transcatheter closure of postmyocardial infarction ventricular septal defect (PIVSD) has emerged as a potential strategy in selected cases. Current interventional reports are mainly restricted to PIVSD closure in the chronic and subacute setting, which only give a short term result. Herein, we report a case of acute post-MI VSR that was successfully closed using an Amplatzer postinfarction muscular ventricular septal defect (PIMVSD) occluder device with good immediate and long-term outcomes. The patient had undergone urgent coronary artery bypass surgery 3 days earlier in the setting of acute MI.

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Mentions: A 73-year-old man with a history of hypertension and dyslipidemia was admitted to our Cardiology Department due to anterior S-T segment elevation acute MI. He was hemodynamically stable and was initially treated with thrombolytic therapy. Urgent coronary angiography was planned because of the absence of reperfusion and hemodynamic deterioration. Transthoracic echocardiography revealed LV enlargement, akinesia of anterior, septal and all apical segments with left ventricular ejection fraction of about 25%. Mild to moderate MR was also noted. There was no post MI mechanical complication. An intra-aortic balloon pump was inserted and coronary angiography was performed which showed severe three-vessel disease that was not amenable to percutaneous intervention. Surgical revascularization was conducted on the second day of admission. After the operation, he was stable for three days, however, he subsequently developed progressive dyspnea, tachycardia and hypotension. Cardiovascular examination was remarkable for a new harsh holosystolic murmur heard maximally at the left lower sternal border. His blood pressure was 95/50 mm Hg and rales were present in the bases of the lungs. Transthoracic echocardiogram showed an apical moderate size simple VSD measuring by color Doppler echocardiography (LV side: 12 mm, RV side: 9 mm, apical rim: 8 mm) with bidirectional shunting (Figure 1). RV systolic pressure was estimated as 55 mm Hg from a tricuspid regurgitant jet velocity of 3.4 m/s. Due to the patient’s clinical condition, and his refusal to redo cardiac surgery, interventional VSD closure was planned under fluoroscopy and real time transesophageal echocardiography (TEE) (Vivid 3, GE, USA) guidance.


Transcatheter Closure of Postinfarction Ventricular Septal Defect: A Case Report and Review of Literature.

Shabestari MM, Ghaderi F, Hamedanchi A - J Cardiovasc Thorac Res (2015)

© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492183&req=5

Mentions: A 73-year-old man with a history of hypertension and dyslipidemia was admitted to our Cardiology Department due to anterior S-T segment elevation acute MI. He was hemodynamically stable and was initially treated with thrombolytic therapy. Urgent coronary angiography was planned because of the absence of reperfusion and hemodynamic deterioration. Transthoracic echocardiography revealed LV enlargement, akinesia of anterior, septal and all apical segments with left ventricular ejection fraction of about 25%. Mild to moderate MR was also noted. There was no post MI mechanical complication. An intra-aortic balloon pump was inserted and coronary angiography was performed which showed severe three-vessel disease that was not amenable to percutaneous intervention. Surgical revascularization was conducted on the second day of admission. After the operation, he was stable for three days, however, he subsequently developed progressive dyspnea, tachycardia and hypotension. Cardiovascular examination was remarkable for a new harsh holosystolic murmur heard maximally at the left lower sternal border. His blood pressure was 95/50 mm Hg and rales were present in the bases of the lungs. Transthoracic echocardiogram showed an apical moderate size simple VSD measuring by color Doppler echocardiography (LV side: 12 mm, RV side: 9 mm, apical rim: 8 mm) with bidirectional shunting (Figure 1). RV systolic pressure was estimated as 55 mm Hg from a tricuspid regurgitant jet velocity of 3.4 m/s. Due to the patient’s clinical condition, and his refusal to redo cardiac surgery, interventional VSD closure was planned under fluoroscopy and real time transesophageal echocardiography (TEE) (Vivid 3, GE, USA) guidance.

Bottom Line: Ventricular septal rupture (VSR) is an uncommon but serious complication of acute myocardial infarction (MI), associated with a high mortality rate.Although early surgical treatment improves the prognosis, hospital mortality after emergency surgery remains high.Herein, we report a case of acute post-MI VSR that was successfully closed using an Amplatzer postinfarction muscular ventricular septal defect (PIMVSD) occluder device with good immediate and long-term outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT
Ventricular septal rupture (VSR) is an uncommon but serious complication of acute myocardial infarction (MI), associated with a high mortality rate. Although early surgical treatment improves the prognosis, hospital mortality after emergency surgery remains high. Transcatheter closure of postmyocardial infarction ventricular septal defect (PIVSD) has emerged as a potential strategy in selected cases. Current interventional reports are mainly restricted to PIVSD closure in the chronic and subacute setting, which only give a short term result. Herein, we report a case of acute post-MI VSR that was successfully closed using an Amplatzer postinfarction muscular ventricular septal defect (PIMVSD) occluder device with good immediate and long-term outcomes. The patient had undergone urgent coronary artery bypass surgery 3 days earlier in the setting of acute MI.

No MeSH data available.


Related in: MedlinePlus