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[Occlusion of interventricular septal rupture in 2 patients with an infarction]
1Departamento de Hemodinamia, Hospital de Especialidades Centro Medico La Raza IMSS, México, D.F.
Insights
This study details a novel balloon-catheter technique to stabilize patients with interventricular septal rupture after myocardial infarction. The intervention temporarily reduced blood flow shunting, though patient outcomes remained poor.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Interventricular septal rupture is a rare but life-threatening complication following myocardial infarction.
- Hemodynamic instability often necessitates urgent intervention prior to surgical repair.
Observation:
- A balloon-catheter was inserted via the aorta into the left ventricle and inflated in the right ventricle through the septal defect.
- This technique aimed to stabilize hemodynamics by reducing the pulmonary to systemic blood flow ratio and arteriovenous blood flow shunt.
Findings:
- The balloon occlusion decreased the pulmonary to systemic blood flow ratio by 6-26% and arteriovenous shunt by 8-31%.
- Pulmonary arterial resistance increased, while pulmonary and systemic arterial pressures remained unchanged.
- Post-occlusion, oxymetric differences suggested reduced shunting, with a trend toward decreased pulmonary blood flow and pressure.
Implications:
- Temporary balloon occlusion may offer hemodynamic stabilization in acute interventricular septal rupture.
- Despite stabilization, the high mortality underscores the critical nature of this condition and the need for effective treatments.
- Further research is warranted to optimize this technique and improve patient survival rates.
Abstract:
We describe two women with interventricular septal rupture secondary to a myocardial infarction due to a total obstruction of the anterior descendent coronary artery. With the aim to stabilize the hemodynamic state of the patients before the surgical closure of the defect, we inserted a balloon-catheter introducing it to the left ventricle from the aorta and inflating it in the right ventricle after passing it through the septal orifice. After occlusion, we observed decreases in the pulmonary to systemic blood flow ratio (6% in one patient and 26% in the other) and in the arteriovenous blood flow shunt (8 and 31%); a 10% systemic blood flow increase was observed in one patient. Since the pulmonary arterial pressure did not change and the pulmonary blood flow increased, an increase of the pulmonary arterial resistance was observed but no modification of the pulmonary and systemic arterial pressure occurred. In the following days, the oxymetric differences between the pulmonary artery and the right atrium showed a tendency to remain below the figures before occlusion and the pulmonary blood flow and pressure showed a tendency to decrease. One patient died 14 days after the surgical closure of the rupture, and the other, seven days after the balloon occlusion of the rupture before any surgery. We present the physiological evolution of the patients.