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1.
Kyobu Geka ; 74(11): 954-958, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34601481

RESUMO

We report a case in which infarct exclusion technique was used to repair residual shunt after extended sandwich patch technique for postinfarction ventricular septal perforation (VSP). A 76-yearold woman was diagnosed with postinfarction VSP and underwent extended sandwich patch technique through right ventriculotomy on the third day after the onset of VSP. No residual shunt was then observed by intraoperative transesophageal echocardiography, but a slight residual shunt was observed on the 7th day after operation. She had no symptom of cardiac failure, and was followed up. However, the residual shunt worsened, and she developed cardiac failure on the 48th day after the initial operation. An additional operation by infarct exclusion technique was performed. No residual shunt was observed after the additional operation. She has been doing well with no signs of cardiac failure.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Infarto do Miocárdio , Ruptura do Septo Ventricular , Idoso , Feminino , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Próteses e Implantes , Reoperação , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia
2.
BMJ Case Rep ; 14(9)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493556

RESUMO

We report a case of a ventricular septal rupture (VSR) which occurred during coronary artery bypass grafting (CABG) operation. The procedure took place 5 days after ST-elevation myocardial infarction of the inferior wall. The VSR repair was not performed at the time of the CABG operation. The intention was to wait until scar formation occurs to facilitate the repair. The patient was supported with venoarterial extracorporeal membranous oxygenation (VA-ECMO) and additional intra-aortic balloon pump (IABP) on intensive care unit. Ten days after CABG the patient underwent a successful VSR repair and 5 days later was weaned from VA-ECMO. He was discharged from hospital 6 weeks after the initial CABG. This case report underlines the importance of VA-ECMO and a multidisciplinary approach with frequent examination of haemodynamic state in the treatment of patients with mechanical complications of myocardial infarction who are not suitable for immediate repair.


Assuntos
Oxigenação por Membrana Extracorpórea , Infarto do Miocárdio , Ruptura do Septo Ventricular , Ponte de Artéria Coronária , Humanos , Balão Intra-Aórtico , Masculino , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia
3.
Tex Heart Inst J ; 48(3)2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34383957

RESUMO

During the coronavirus disease 2019 (COVID-19) pandmic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case highlights a potential long-lasting negative effect that the COVID-19 pandemic will have on the care-seeking behavior and health of patients with acute cardiovascular disease.


Assuntos
COVID-19 , Cateterismo Cardíaco/métodos , Ponte de Artéria Coronária/métodos , Medo , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST , Ruptura do Septo Ventricular , Idoso , COVID-19/epidemiologia , COVID-19/psicologia , Angiografia Coronária/métodos , Ecocardiografia/métodos , Eletrocardiografia/métodos , Humanos , Masculino , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Tempo para o Tratamento/tendências , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/fisiopatologia , Ruptura do Septo Ventricular/cirurgia
4.
J Card Surg ; 36(10): 3933-3935, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34291837

RESUMO

A 74-year-old woman developed inferior myocardial infarction due to right coronary artery occlusion and underwent percutaneous coronary intervention. Two days later, echocardiography revealed ventricular septal rupture, and Impella CP was inserted to avoid emergency surgery. However, the patient's hemodynamics deteriorated rapidly, necessitating additional venoarterial extracorporeal membranous oxygenation support with concomitant Impella support (ECPELLA). The ventricular septal rupture was surgically repaired using the extended sandwich technique via a right ventricular approach; the ascending aorta was clamped with the clampable portion of the Impella. The patient was successfully weaned from the Impella 3 days postsurgery. This case suggests that urgent surgery with ECPELLA support could be a useful option for patients with ventricular septal rupture, even in severe cases wherein emergency surgery is unavoidable.


Assuntos
Oxigenação por Membrana Extracorpórea , Ruptura do Septo Ventricular , Idoso , Ecocardiografia , Feminino , Ventrículos do Coração , Hemodinâmica , Humanos , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia
5.
J Card Surg ; 36(7): 2253-2262, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33834536

RESUMO

INTRODUCTION: Ventricular septal rupture (VSR) is a serious mechanical complication after acute coronary syndrome and is related to high mortality. Even with advances in the management of acute myocardial infarction (AMI) such as reperfusion therapies, complication rates are still high. During quarantine, patients presenting mechanical complications after AMI have increased in our institution. METHODS: From a retrospective database analysis in our institution between the years 2004 and 2020, we identified 37 cases of VSR after AMI. Four chronic cases were excluded from our analysis. The primary endpoint was to identify baseline characteristics that increased 30-day mortality. RESULTS: Among 33 acute cases of VSR, 24 cases were submitted to surgery. The 30-day mortality of the operated patients was 45.8%. From 2004 to 2019 our average number of operations of VSR was 1.9 cases/year with an increase to 4 cases/year in 2020. Diabetes mellitus, age, cardiogenic shock, and use of intra-aortic balloon pump were associated with significantly increased mortality using logistic regression. CONCLUSION: We reported an increased number of mechanical complication cases from April to September 2020, compared to our historical records. Despite therapeutic advances, mortality rates remain high. Although the number of cases is small to conclude that the pandemic was responsible for this augmentation, we believe that it is related to the decreased number of patients seeking medical assistance.


Assuntos
Infarto do Miocárdio , Ruptura do Septo Ventricular , Humanos , Balão Intra-Aórtico , Infarto do Miocárdio/complicações , Estudos Retrospectivos , Choque Cardiogênico/etiologia , Ruptura do Septo Ventricular/epidemiologia , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia
7.
Heart Lung Circ ; 30(7): 978-985, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33495129

RESUMO

BACKGROUND: This study was performed to assess long-term survival and identify risk factors for acute myocardial infarction in patients complicated with ventricular septal rupture (VSR). METHOD: A retrospective analysis of 116 patients with post-infarction VSR (PI-VSR) hospitalised in Beijing Anzhen Hospital from January 2008 to February 2019 was performed. The independent risk factors for in-hospital mortality were assessed using multivariate analysis with a logistic regression model. The Kaplan-Meier method and log-rank test were carried out for long-term survival in the surgery group. RESULTS: The overall in-hospital mortality rate was 47.4%. Logistic regression analysis revealed that age (p<0.05), female sex (p<0.05), no surgical repair (p<0.05), liver dysfunction (p<0.05), high heart rate (p<0.05), and low platelet count (PLT; p<0.05) were independent risk factors for in-hospital mortality. The 1-year mortality rate was lower in the surgery group than in the medical treatment group (18.3% vs 84.5%; p<0.005). During the mean follow-up of 5.2±5.1 years (median, 1.3 years), the actuarial survival rates of these patients at 5 and 10 years were 72.3% and 43.2%, respectively. CONCLUSIONS: The overall in-hospital mortality rate remained high. The independent risk factors for in-hospital mortality associated with PI-VSR were age, female sex, no surgical repair, liver dysfunction, tachycardia, and low PLT level. The 1-year mortality and long-term outcomes of patients treated with surgery were significantly better than those of patients who were treated conservatively.


Assuntos
Infarto do Miocárdio , Ruptura do Septo Ventricular , Feminino , Humanos , Infarto do Miocárdio/complicações , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ruptura do Septo Ventricular/epidemiologia , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia
8.
Ann Thorac Surg ; 112(3): e161-e163, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33482161

RESUMO

Optimal timing of surgical repair for patients diagnosed with a post-myocardial infarction ventricular septal rupture is controversial. Urgent surgical intervention to prevent hemodynamic decompensation must be balanced against delayed repair to allow for tissue stabilization and increased likelihood of a successful outcome. We report the use of an axillary Impella 5.5 (Abiomed Inc, Danvers, MA) temporary left ventricular assist device to aid in hemodynamic stabilization, shunt fraction reduction, and tissue maturation with eventual definitive surgical repair in a patient who presented with a post-myocardial infarction ventricular septal rupture and cardiogenic shock.


Assuntos
Coração Auxiliar , Infarto do Miocárdio/complicações , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia , Idoso , Humanos , Masculino
9.
Heart Lung ; 50(2): 292-295, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33387761

RESUMO

The COVID 19 pandemic resulted in a total reduction in the number of hospitalizations for acute coronary syndromes. A consequence of the delay in coronary revascularization has been the resurgence of structural complications of myocardial infarctions. Ventricular septal rupture (VSR) complicating late presenting acute myocardial infarction (AMI) is associated with high mortality despite advances in both surgical repair and perioperative management. Current data suggests a declining mortality with delay in VSR repair; however, these patients may develop cardiogenic shock while waiting for surgery. Available options are limited for patients with VSR who develop right ventricular failure and cardiogenic shock. The survival rate is very low in patients with cardiogenic shock undergoing surgical or percutaneous VSR repair. In this study we present two late presenting ST elevation MI patients who were complicated by rapidly declining hemodynamics and impending organ failure. Both patients were bridged with venoarterial extracorporeal membrane oxygenation (ECMO) to cardiac transplant.


Assuntos
COVID-19 , Infarto do Miocárdio com Supradesnível do Segmento ST , Ruptura do Septo Ventricular , Humanos , Pandemias , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Choque Cardiogênico/etiologia , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico , Ruptura do Septo Ventricular/epidemiologia , Ruptura do Septo Ventricular/etiologia
10.
Gen Thorac Cardiovasc Surg ; 69(2): 336-339, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32632758

RESUMO

A 59-year-old woman fell into cardiogenic shock due to acute myocardial infarction with total occlusion of the left anterior descending artery. Although intra-aortic balloon pump was inserted and a coronary stent was placed, she went into cardiopulmonary arrest and percutaneous veno-arterial extracorporeal membrane oxygenation (ECMO) was initiated. She was transferred to our hospital after drainage for pericardial effusion. Computed tomography revealed the drainage catheter lying through the right ventricular free wall and the ventricular septum, and leading into the left ventricle. She showed multiple organ failure and disseminated intravascular coagulation syndrome due to insufficient ECMO flow. Conversion to central ECMO after catheter removal was performed and her general condition improved; however, ventricular septal shunt remained. Repair of the perforation and ECMO removal was performed 15 days after the first operation. The combination of optimal mechanical circulatory support and the staged surgical repair contributed to her dramatic recovery.


Assuntos
Choque Cardiogênico , Ruptura do Septo Ventricular , Cateteres , Feminino , Humanos , Doença Iatrogênica , Balão Intra-Aórtico , Pessoa de Meia-Idade , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia
11.
Gen Thorac Cardiovasc Surg ; 69(1): 110-113, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32529504

RESUMO

A 77-year-old woman who presented with chest pain was diagnosed with acute anterior myocardial infarction. Echocardiography revealed pericardial effusion, and she underwent sutureless repair for postinfarction left ventricular free wall rupture. Echocardiography performed 2 days postoperatively revealed ventricular septal rupture and left ventricular acute dilatation. Hemodynamic instability with ventricular tachycardia and rapid decline of kidney function developed. Four days after the primary surgery, we performed successful sandwich repair for ventricular septal rupture and the dilatation. Her postoperative course was uneventful, and postoperative evaluation did not show a residual shunt or left ventricular dilatation.


Assuntos
Ruptura Cardíaca , Ruptura do Septo Ventricular , Idoso , Dor no Peito , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia
13.
Artigo em Inglês | MEDLINE | ID: mdl-33263363

RESUMO

The development of a postmyocardial infarction ventricular septal rupture is an uncommon but frequently fatal complication. Mortality with medical treatment only is extremely high. Septal rupture results in a left-to-right shunt, with right ventricular volume overload, increased pulmonary blood flow, and secondary volume overload of the left atrium and ventricle.  Surgical treatment consists of excluding rather than excising the infarcted septum and ventricular walls. This is accomplished by performance of a left ventriculotomy through the infarcted muscle and securing a glutaraldehyde-fixed bovine pericardium patch to the endocardium of the left ventricle all around the infarcted myocardium.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Endocárdio/cirurgia , Comunicação Interventricular , Ventrículos do Coração , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular , Idoso , Bioprótese , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia/métodos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/etiologia , Comunicação Interventricular/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Hemodinâmica , Humanos , Pericárdio/transplante , Transplantes , Ruptura do Septo Ventricular/diagnóstico , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia
16.
Int Heart J ; 61(4): 831-837, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32728002

RESUMO

Ventricular septal rupture (VSR) is one of the fatal complications of myocardial infarction in the percutaneous coronary intervention era. A rapid diagnosis, medical and mechanical support, and surgical intervention are required for recovery and survival. In such a situation, the risk of complications associated with surgery is very high, especially in very elderly patients, in which any therapeutic strategy should be carefully discussed by the heart team. Herein, we describe two cases of VSRs after recent myocardial infarction (RMI) in very elderly patients that required debate regarding whether to perform surgery. The patients included a 93-year-old man and 89-year-old man, both of which were not highly frail before the RMI occurred. In the former case, a conservative strategy was adopted because the risk of surgery was considered, but he did not survive. On the other hand, the latter patient underwent surgery and his life was ultimately saved. Based on these two cases, we concluded that even if the patients are very old, if possible, surgical intervention should be fully considered.


Assuntos
Tratamento Conservador/métodos , Infarto do Miocárdio/complicações , Intervenção Coronária Percutânea/efeitos adversos , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia , Idoso de 80 Anos ou mais , Ecocardiografia/métodos , Eletrocardiografia/métodos , Evolução Fatal , Idoso Fragilizado , Humanos , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/fisiopatologia
18.
Heart ; 106(12): 878-884, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32111641

RESUMO

Postinfarct ventricular septal defects (VSDs) are a mechanical complication of acute myocardial infarction (AMI) with a very poor prognosis. They are estimated to occur in 0.2% of patients presenting with AMI, with 1-month survival of 6% without intervention. Guidelines recommend surgical repair, but recent advances in transcatheter technology, and bespoke device development, mean it is increasingly viable as a closure option. Surgical mortality is between 30% and 50% for all-comers, while in series of transcatheter closure, mortality was 32%. Transcatheter closure appears durable, with no evidence of late leaks and low long-term mortality in series with up to 5-year follow-up. Guidelines recommend early closure, which is likely to provide most benefit for patients regardless of the closure method. Multimodality cardiac imaging including echocardiography, CT and cardiac MRI can define size, shape, location of defects and their relationship to other cardiac structures, assisting with treatment decisions. Brief delay to allow stabilisation of the patient is appropriate, but untreated patients risk rapid deterioration. Mechanical circulatory support may be helpful, although the preferred modality is unclear. Transcatheter closure involves large bore venous access and the formation of an arteriovenous loop (under fluoroscopic and trans-oesophageal echocardiographic guidance) in order to facilitate deployment of the device in the defect and close the postinfarct VSD. Guidelines suggest transcatheter closure as an alternative to surgical repair in centres where appropriate expertise exists, but decisions for all patients with postinfarct VSD should be led by the multidisciplinary heart team.


Assuntos
Cateterismo Cardíaco , Idoso , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/mortalidade , Ruptura do Septo Ventricular/fisiopatologia
19.
Cardiol Young ; 30(1): 134-135, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31916528

RESUMO

This report describes a 3-year-old infant with post-operative mediastinitis complicated by a contained rupture of the right ventricle. A contained rupture is recognised as the huge pulsating prominence of the anterior chest wall. CT confirmed blood communication between the right ventricular outflow tract and the cavity surrounded by the pectoral major musculocutaneous flap. This is a significant case in which severe adhesion between the right ventricle and the musculocutaneous flap could maintain her stable haemodynamics with a pulsating prominence.


Assuntos
Transposição das Grandes Artérias/efeitos adversos , Dupla Via de Saída do Ventrículo Direito/cirurgia , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia , Pré-Escolar , Feminino , Ventrículos do Coração/lesões , Ventrículos do Coração/cirurgia , Humanos , Mediastinite/microbiologia , Retalho Miocutâneo/transplante , Complicações Pós-Operatórias/cirurgia , Reoperação , Tomografia Computadorizada por Raios X
20.
Gen Thorac Cardiovasc Surg ; 68(6): 629-632, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31093943

RESUMO

An 84-year-old man who underwent percutaneous coronary intervention for acute inferior myocardial infarction due to occlusion of the mid portion of the right coronary artery was transferred to our hospital because of post-infarction posterior ventricular septal rupture. We performed the extended sandwich technique via the right atrial approach as well as tricuspid and mitral valve replacement and permanent pacemaker implantation. Mild residual shunt was detected post-operatively, but the patient's condition was controlled well with diuretics.


Assuntos
Ruptura do Septo Ventricular/cirurgia , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/métodos , Átrios do Coração/cirurgia , Humanos , Masculino , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular/etiologia
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