Ventricular Septal Rupture Management in Patients With Acute Myocardial Infarction: A Review

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Untreated myocardial infarction (MI) can lead to fatal complications like ventricular septal rupture (VSR).
• VSR requires immediate hemodynamic stabilization and septal rupture closure.
• Conventional treatment involves surgical repair, but percutaneous transcatheter repair is emerging.

Purpose of the Study:

• To review incidence, risk factors, and pathophysiology of MI leading to VSR.
• To analyze current and emerging management strategies for post-infarction VSR.
• To evaluate the efficacy and optimal timing of VSR closure interventions.

Main Methods:

• Comprehensive review of published literature on myocardial infarction and ventricular septal rupture.
• Analysis of trends in VSR incidence and associated risk factors.
• In-depth examination of surgical and percutaneous treatment modalities.

Main Results:

• Thrombolysis is crucial in ST-elevated MI, significantly decreasing VSR occurrence.
• Delayed surgical closure remains the primary treatment for post-infarction VSR.
• Percutaneous closure devices and mechanical circulatory support are promising alternatives, but their efficacy in high-risk patients is still under investigation.

Conclusions:

• Optimal timing for VSR closure is controversial, with earlier surgical repair increasing mortality risk.
• Percutaneous interventions and mechanical circulatory support show potential but require further validation in high-risk populations.
• While surgical closure is traditional, its high operative risk necessitates exploration of less invasive strategies.