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Surgical treatment of ventricular septal defect secondary to myocardial infarction
I Kallela1, J Salo, M Nieminen
1Department of Thoracic and Cardiovascular Surgery, University Central Hospital, Helsinki, Finland.
Insights
Surgical repair of ventricular septal defects after myocardial infarction offers a chance for survival, but carries high risks. Early intervention is crucial, though outcomes are worse with initial shock or inferior infarctions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Pathology
Background:
- Ventricular septal defect (VSD) is a rare but serious complication following myocardial infarction (MI).
- Surgical management of post-MI VSD presents significant challenges due to patient comorbidities and infarct-related tissue damage.
Purpose of the Study:
- To evaluate the outcomes of surgical intervention for ventricular septal defects secondary to myocardial infarction.
- To identify factors influencing operative mortality and long-term survival in this patient cohort.
Main Methods:
- Retrospective analysis of 13 patients undergoing VSD repair between 1974 and 1988.
- Surgical procedures included VSD correction, with concomitant coronary artery bypass grafting (CABG) in 6 and left ventricular aneurysmectomy in 3 patients.
- Data collected on operative details, mortality, complications, and long-term follow-up.
Main Results:
- Operative mortality was 31%, with low output syndrome and left ventricular free wall rupture as primary causes of death.
- Postoperative shunting occurred in 5 patients.
- During a mean follow-up of 6.3 years, 3 patients died from subsequent myocardial infarctions; survivors were in NYHA class II.
Conclusions:
- Prompt diagnosis and surgical treatment of post-MI VSD are recommended.
- Outcomes are significantly poorer in patients presenting with initial shock or inferior myocardial infarction.
Abstract:
13 patients were operated on during 1974-88 for ventricular septal defect secondary to myocardial infarction. 7 infarctions were inferior and 6 anterior. At the time of operation 5 patients were in shock. Besides the correction of ventricular septal defect coronary artery by-pass grafting was performed in 6 patients and left ventricular aneurysmectomy in 3 patients. The operative mortality was 31%. The cause of death was low output syndrome in 3 cases and a new rupture through the left ventricular free wall in one case. Postoperative shunting was detected in 5 patients. During an average follow-up time of 6.3 years (range 0.5-15 years) 3 patients died from a new myocardial infarction. The mean performance levels of the patients still living was NYHA II. Prompt diagnosis of a ventricular septal defect due to myocardial infarction and its immediate surgical treatment is recommended. The results are poor in the presence of primary shock and for inferior infarction.