RESUMO
BACKGROUND: Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of an acute myocardial infarction (AMI). Survival to 1 month without intervention is 6%. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. Indian data on percutaneous device closure of post AMI-VSR is scarce hence we report our single-centre experience with ASD occluder device (Amplatzer and lifetech) for closure of post-AMI VSR. METHODS AND RESULTS: In this single-centre, retrospective, cohort study, patients who underwent transcatheter closure of post-MI VSR between 2005 and 2015 at KIMS Hospital were included. Primary outcome was mortality rate at 30 days. Seven patients were included in the study (mean age, 58.29±9.8 years). 5 patients had anterior wall myocardial infarction (AWMI) & 2 had inferior wall myocardial infarction (IWMI). None of the patients received thrombolytic therapy. Device was successfully placed in 5 patients (71.4%) with minimal residual shunt in 2 patients (40%). Out of 7 cases 2 patients survived (29% survival rate) and are doing well on follow up at 1 and 5 years respectively. Cardiogenic shock, IWMI and serpigenious form of VSR were associated with poor outcomes. Delayed revascularization (PCI) was associated with better outcomes. CONCLUSION: Percutaneous closure is a potential technique in a selected group of patients. The presence of cardiogenic shock, IWMI and serpigeneous form of VSR constitutes important risk factors for mortality. Device implantation is in general successful with few procedure-related complications and should be applied on a case-by-case basis.
Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Dispositivo para Oclusão Septal , Choque Cardiogênico/etiologia , Cirurgia Assistida por Computador/métodos , Ruptura do Septo Ventricular/cirurgia , Idoso , Ecocardiografia Transesofagiana , Feminino , Fluoroscopia , Seguimentos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Taxa de Sobrevida/tendências , Resultado do Tratamento , Ruptura do Septo Ventricular/complicações , Ruptura do Septo Ventricular/diagnósticoRESUMO
Intra-cardiac extension of tumour thrombus of follicular carcinoma of thyroid is uncommon. We report a case of advanced thyroid carcinoma where tumour thrombus was well profiled with CT scan and transesophageal echo images and extension was noted from SVC into right atrium, with clinical features of superior vena cava syndrome. The clinical significance of the "ring sign" is discussed.