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Experiences with surgical treatment of ventricle septal defect as a post infarction complication
Kasim Oguz Coskun1, Sinan Tolga Coskun, Aron Frederik Popov
1Department of Thoracic Cardiovascular Surgery, University of Göttingen, Göttingen, Germany. dr_coskunok@yahoo.de
Insights
Surgical repair of post-infarction ventricular septal defects (PVSD) improves outcomes, but cardiogenic shock significantly impacts early results. Optimal timing for PVSD surgery is 4-5 weeks after acute myocardial infarction (AMI).
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Mechanical complications of acute myocardial infarction (AMI) carry a poor prognosis.
- Surgical intervention is crucial for improving cardiac function and hemodynamic stability in these patients.
- Post-infarction ventricular septal defect (PVSD) is a serious mechanical complication requiring surgical consideration.
Purpose of the Study:
- To review the surgical outcomes of patients diagnosed with post-infarction ventricular septal defect (PVSD).
- To identify factors influencing mortality and success rates in surgical repair of PVSD.
- To establish optimal timing for surgical intervention in PVSD cases.
Main Methods:
- Retrospective analysis of hospital records for 41 patients treated for PVSD between 1990 and 2005.
- Data collected included patient age, surgical procedures (e.g., coronary artery bypass grafting), time intervals from infarct to rupture and rupture to surgery, and outcomes.
- Evaluation of mortality rates based on surgical timing and presence of cardiogenic shock.
Main Results:
- Hospital mortality for PVSD surgical repair was 32%.
- Urgent repair within 3 days for cardiogenic shock resulted in 100% mortality.
- Survival was 100% for patients undergoing surgical repair later than 36 days post-infarction.
Conclusions:
- Surgical intervention is vital for mechanical complications post-AMI.
- Cardiogenic shock is a critical factor negatively affecting early surgical outcomes.
- Optimal surgical timing for PVSD repair is recommended 4-5 weeks after AMI, with individualized preoperative management and technique selection.
Background:
Complications of acute myocardial infarction (AMI) with mechanical defects are associated with poor prognosis. Surgical intervention is indicated for a majority of these patients. The goal of surgical intervention is to improve the systolic cardiac function and to achieve a hemodynamic stability. In this present study we reviewed the outcome of patients with post infarction ventricular septal defect (PVSD) who underwent cardiac surgery.
Methods:
We analysed retrospectively the hospital records of 41 patients, whose ages range from 48 to 81, and underwent a surgical treatment between 1990 and 2005 because of PVSD.
Results:
In 22 patients concomitant coronary artery bypass grafting (CAGB) was performed. In 15 patients a residual shunt was found, this required re-op in seven of them. The time interval from infarct to rupture was 8.7 days and from rupture to surgery was 23.1 days. Hospital mortality in PVSD group was 32%. The mortality of urgent repair within 3 days of intractable cardiogenic shock was 100%. The mortality of patients with an anterior VSD and a posterior VSD was 29.6% vs 42.8%, respectively. All patients who underwent the surgical repair later than day 36 survived.
Conclusion:
Surgical intervention is indicated for a majority of patients with mechanical complications. Cardiogenic shock remains the most important factor that affects the early results. The surgical repair of PVSD should be performed 4-5 weeks after AMI. To improve surgical outcome and hemodynamics the choice of surgical technique and surgical timing as well as preoperative management should be tailored for each patient individually.
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