Ventricular Septal Rupture After Myocardial Infarction: JACC Focus Seminar 3/5

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Ventricular septal rupture (VSR) is a severe complication of acute myocardial infarction (MI).
• While less frequent post-thrombolytic therapy, VSR still carries high mortality, often linked to refractory cardiogenic shock.
• Surgical repair, though effective, has significant perioperative risks.

Purpose of the Study:

• To review current and emerging strategies for managing VSR post-MI.
• To highlight the role of less invasive transcatheter closure and mechanical circulatory support.
• To emphasize the importance of multimodality imaging and a heart team approach.

Main Methods:

• Review of current literature on VSR management.
• Discussion of transcatheter closure techniques and percutaneous mechanical circulatory support.
• Emphasis on multimodality imaging for anatomical assessment.
• Exploration of the heart team approach for treatment timing and strategy.
• Consideration of advanced options like heart transplantation and palliative care.

Main Results:

• Transcatheter closure offers a less invasive alternative to surgery, especially in cardiogenic shock.
• Percutaneous mechanical circulatory support aids in stabilizing patients and preserving organ function.
• Multimodality imaging guides the selection of the optimal repair strategy.
• A heart team approach optimizes treatment timing and patient selection for various interventions.
• Deferred treatment and palliative care are considered for specific patient groups.

Conclusions:

• Transcatheter closure and mechanical circulatory support represent significant advancements in VSR management.
• A multidisciplinary heart team approach is crucial for personalized VSR treatment.
• Comprehensive imaging and consideration of advanced/palliative options improve patient outcomes.