Surgical Repair of Post Myocardial Infarction Ventricular Septal Defect: A Retrospective Analysis of a Single Institution Experience-Reference-Cited by-同舟云学术

Surgical Repair of Post Myocardial Infarction Ventricular Septal Defect: A Retrospective Analysis of a Single Institution Experience

Published:2023-04-03 Issue: Volume: Page:
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Author:

Shi Jian¹,Levett Jeremy²,LV Haiyu¹,Zhang Guoan¹,Wang Sha¹,Wei Tao¹,Wang Zhikun¹,Zhang Xi¹,Feng Dawei¹,Wang Kan¹,Liu Qiang¹,Shum-Tim Dominique²

Affiliation:

1. Shaanxi Provincial People’s Hospital

2. McGill University Health Centre, McGill University

Abstract

Abstract INTRODUCTION: Ventricular septal defect (VSD) is a mechanical complication of acute myocardial infarction (MI) with a very high mortality, despite advances in surgical and circulatory support. The tremendous hemodynamic disturbance and the severely fragile myocardium render surgical repair a great challenge. The optimal time of surgical repair with or without circulatory support is still controversial. OBJECTIVE The aim of this study is to review our experience with early surgical repair of post-MI VSD in a single major cardiac institution in China. METHODS From January 2013 to October 2020, 9consecutive patients presented to our emergency department with a diagnosis of post-MI VSD. Among them, 8 were male, and the mean age was 58 ± 7years. The mean VSD size was 22.5 ± 5.7 mm. In all patients, an intra-aortic balloon pump (IABP)was inserted immediately after admission to cardiac surgery service. All patients were operated within one week of the rupture (range of surgery time 1 to 9 days post-VSR, mean 3.3 ± 2.9 days, and 4 within 24 hours. In 5 cases, the VSD was located superiorly, and 4 cases in the posterior septum. RESULTS The overall 30-day mortality was 11% (1/9). All patients underwent urgent percutaneous coronary intervention (PCI), and 5 additional coronary artery bypass grafting (CABG) during VSD repair. There was no death in all 5 patients with anterior septal perforation. One patient with posterior septal perforation died in the operating room due to bleeding from the ventriculotomy site. Three survived patients were diagnosed witha small residual defect and mild left to right shunt post-repair. However, no further intervention was required, and patients remained asymptomatic (NYHA class II in 1 and III in 2). CONCLUSION In our experience, early surgical repair of post-MI VSD and concomitant coronary revascularization after hemodynamic stabilization and proper rescucitationcan beachieved with favorable survival and earlyoutcomes.

Publisher

Research Square Platform LLC

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