Multicentre short- and medium-term report on the device closure of a post-myocardial infarction ventricular septal rupture - In search of risk factors for early mortality.

BACKGROUND: Post-myocardial infarction ventricular septal rupture (VSR) is a rare and severe complication of myocardial infarction. To find early mortality (<30 days) risk factors of device VSR closure and to evaluate its medium-term outcome. METHODS: Multicenter retrospective analysis on all 46 consecutive patients with percutaneous (n = 43) or hybrid (n = 3) VSR closure in 2000-2020 with various nitinol wire mesh occluders. Medical records, hemodynamic data, procedure results, short- and mid-term follow-up were analyzed (4.8 ± 3.7 years, range: 0.1-15, available in 61.7% of patients). Of the patients, 34.8% underwent VSR closure in acute phase (<21 days after VSR occurrence), 17.4% underwent device closure due to significant residual shunt after previous VSR surgery. RESULTS: Success rate was 78.3%. More than moderate residual shunt, major complications, and early surgical reintervention affected 18.9%, 15.2% (including 2 intra-procedural deaths), and 21.7% of patients, respectively. Early mortality was 26.1% (13.9% in successful vs. 70% in unsuccessful closure; p < 0.001). Older age, need for intra-aortic balloon counterpulsation, severe complications, and procedural failure were identified as risk factors for early mortality. Among patients who survived the early period, the 5-year survival rate was 57.1%. NYHA class improved in 88.2% patients at the latest follow-up. CONCLUSIONS: Procedure of VSR device closure demonstrates an acceptable technical success rate; however, the incidence of severe complications and early mortality is notably high. Older patients in poor hemodynamic condition and those with unsuccessful occluder deployment are particularly at a higher risk of a fatal outcome. The prognosis after early survival is promising.

Polyarteritis Nodosa in Infancy – Generalized Vascular Problem Diagnosed after Initial Cardiac Manifestation in Emergency Cardiovascular Catheterization.

Aim: Coronary artery diseases in children are uncommon, but in selected cases general vascular problems also affect the heart. Case: We present the case of 4-month old girl admitted to Pediatric Intensive Care Unit after the incident of cardiac arrest and ventricular tachycardia, who underwent diagnostic catheterization due to cardiac ischemia. Coronary angiography showed changes in coronary arteries in the form of disseminated aneurysms, mixed with severely stenosed segments. General angiography discovered also changes in the number of peripheral arteries, with the most significant right subclavian and left iliac artery aneurysms. Results: Upon angiographic images and a history of untreated infection, polyarteritis nodosa (PAN) was diagnosed, with an appropriate administration of intensive treatment. Conclusion: The case prove the significance of invasive cardiovascular diagnostics (cardiac catheterization) in every unclear clinical course.