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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Not all Postmyocardial Infarction Ventricular Septal Rupture Need Immediate Surgery: Role of Cardiogenic Shock

Mohammed Azizul Hasan Khandaker1, Prashanth Panduranga1

  • 1Department of Cardiology, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman.

Heart Views : the Official Journal of the Gulf Heart Association
|September 29, 2021
PubMed

Insights

This study highlights the critical role of the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages in managing patients with ST elevation myocardial infarction and ventricular septal rupture (VSR). Timely surgical intervention, guided by shock classification, improves outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Acute anterior ST elevation myocardial infarction can lead to ventricular septal rupture (VSR).
  • Ventricular septal rupture (VSR) presents a significant surgical challenge, especially in the context of cardiogenic shock.
  • The Society for Cardiovascular Angiography and Intervention (SCAI) classification system provides a framework for assessing shock severity.

Observation:

  • A 56-year-old man with ST elevation myocardial infarction developed multiple apical muscular ventricular septal defects (VSR) with a left-to-right shunt and significant gradient.
  • Coronary angiography revealed severe stenosis in the left anterior descending artery (LAD) and right posterior descending artery (r-PDA).
  • The patient was classified as SCAI cardiogenic shock Stage B, prompting conservative management initially.

Findings:

  • Surgical intervention for VSR was delayed until the 18th day, guided by the SCAI shock stage classification.
  • The patient underwent successful VSR repair with a Gortex patch and received a graft to the r-PDA.
  • The decision to graft the r-PDA instead of the LAD was due to visualization difficulties.

Implications:

  • The SCAI shock stage classification is crucial for determining optimal surgical timing in post-myocardial infarction VSR.
  • This approach aids in stabilizing the infarct area, potentially leading to better surgical outcomes.
  • Multidisciplinary collaboration between cardiology and cardiac surgery is essential for managing complex cases of myocardial infarction with VSR.

Keywords:
Acute myocardial infarctionechocardiographyventricular septal rupture

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