Post-infarction ventricular septal defect surgery in Portugal.

INTRODUCTION AND OBJECTIVE: We performed a collective analysis of a dedicated national post-myocardial infarction ventricular septal defect (VSD) registry to further elucidate controversial areas of this clinical entity's surgical treatment. METHODS: A descriptive statistical analysis was carried out and cumulative survival using the Kaplan-Meier method and multivariate logistic regression of risk factors for 30-day mortality are presented. RESULTS: Median survival of the cohort (n=76) was 72 months (95% CI 4-144 months). Better cumulative survival was observed in patients who underwent VSD closure more than 10 days after myocardial infarction (log-rank p=0.036). Concomitant coronary artery bypass grafting (CABG), different closure techniques, location of the VSD, extracorporeal membrane oxygenation as bridge to closure, or intra-aortic balloon pump as bridge to closure showed no statistically significant differences at Kaplan-Meier analysis. Multivariate binary logistic regression for independent factors affecting status at 30 days showed a statistically significant effect of age (OR 1.08; 95% CI 1.01-1.15) and concomitant CABG (OR 0.23; 95% CI 0.06-0.90). CONCLUSIONS: Our results are comparable with previous reports regarding mortality, risk factors and concomitant procedures. Timing of surgery remains a controversial issue. Later closure seems to be advantageous, however, there is significant observational bias.

CIV Pós-IM de parede inferior com ótima evolução pós-operatória: apresentação incomum de uma complicação cada vez menos frequênte / Ventricular septal rupture after inferior wall myocardial infarction with an excellent outcome after cardiac surgery: an uncommon presentation of a less and less frequent complication

Apesar de comumente citada como complicação mecânica do infarto agudo do miocárdio, a comunicação interventricular (CIV) ocorre com frequência cada vez menor após o advento da terapia trombolítica. Neste relato, os autores descrevem o caso de um homem de 54 anos com CIV após 8 dias de infarto de parede inferior, com características clínicas, eletrocardiográficas e ecocardiográficas peculiares e uma ótima evolução após cirúrgia cardíaca.

Despite being commonly referred to as a mechanical complication of acute myocardial infarction, ventricular septal rupture (VSR) has occurred less andless frequently since the breakthrough ofthrombolytic therapy. In this case report, the authors describe a 65-year-old man with a VSR 8 days after an inferior wall infarction, with particular clinical, electrocardiographic, and echocardiographic features and an excellent outcome after cardiac surgery.