Related Experiment Videos
Treatment of ventricular septal defect after myocardial infarction
D J Gillmer1, J A Odell, A S Mitha
1Department of Cardiology, Wentworth Hospital, Durban.
Insights
Ventricular septal defect after myocardial infarction can be managed with diuretics and vasodilators, allowing delayed surgery. This approach leads to good patient outcomes with stable hemodynamics and fibrosis for safe closure.
Area of Science:
- Cardiology
- Cardiac Surgery
- Internal Medicine
Background:
- Ventricular septal defect (VSD) is a rare but serious complication following myocardial infarction (MI).
- These defects often present with severe hemodynamic compromise, including pulmonary hypertension and significant left-to-right shunting.
- Prompt management is crucial for patient survival and recovery.
Purpose of the Study:
- To evaluate the efficacy of initial medical management with diuretics and vasodilators for VSD post-MI.
- To assess the safety and outcomes of delayed surgical repair in these patients.
- To determine the optimal timing for surgical intervention based on septal tissue characteristics.
Main Methods:
- Retrospective review of 6 VSD post-MI cases treated between 1978 and 1984.
- All patients underwent cardiac catheterization to assess shunt size and pulmonary pressures.
- Initial treatment involved high-dose diuretics and vasodilators, followed by delayed surgical closure (mean 6 weeks post-rupture).
Main Results:
- Patients presented with severe pulmonary hypertension and large left-to-right shunts (mean 64%).
- Initial medical therapy successfully stabilized patients with congestive cardiac failure.
- Follow-up ranging from 1 to 7 years showed one late non-cardiac death; all other patients were well.
Conclusions:
- Initial stabilization with diuretics and vasodilators is effective for VSD post-MI presenting with heart failure.
- Delayed surgical intervention, after allowing for septal fibrosis, can be performed safely.
- This conservative approach to timing of surgery improves outcomes in this challenging patient group.
Abstract:
Between 1978 and 1984 6 cases of ventricular septal defect after myocardial infarction were referred to this hospital. All 6 patients underwent cardiac catheterisation, had severe pulmonary hypertension and large left-to-right shunts (mean 64%). They were treated with high doses of diuretics and vasodilators, and underwent delayed surgery 6 weeks after rupture. Follow-up is from 1 to 7 years. There has been 1 late, non-cardiac death. The remainder are well. In our experience patients with congestive cardiac failure complicating ventricular septal defect after infarction can be stabilized initially on diuretic and vasodilator therapy, and surgery can safely be deferred until septal fibrosis allows adequate closure.