Title: Post Myocardial Infarction Ventricular Septal Rupture, Early Surgery – Is It Beneficial?
Authors: Dr Ravikumar Nagashetty, Dr Pranav Janardhan Adoni, Dr Rakesh Seetharaman, Dr Giridhar Kamalapurka
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.86
Abstract
Introduction: Ventricular septal defect (VSD) is a rare but potentially fatal complication of acute myocardial infarction. In this report we aimed to study the characteristics and outcomes of patients who underwent surgical repair of post-infarction VSD using the excision technique.
Methodology: We performed a retrospective review of hospital records of all patients who were treated for post-infarction VSD using the excision surgical technique at the Department of Cardiothoracic Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka from 2005 till 2017. Preoperative characteristics of the patients like age, gender, past medical history, location of infarction and VSD, echocardiographic investigations and postoperative status of the patient with respect to need for IABP, extubation, inotropic weaning, mean hospital stay and residual septal defects were noted for the patients.
Results: During the study period we operated on 16 patients (7 females) with mean age of 58.7 years. Mean time between infarction and VSD was 5.2 days and time between symptom development due to VSD and surgery ranged from one to thirty days. Myocardial infarction of the anterior wall, anterolateral wall and inferior wall was seen in 7, 8 and 1 patient respectively. Preoperative echocardiography found reduced left ventricular function in all patients and ascertained VSD to be antero-apical in 8, mid-septal in 7 and posterior in 1 patient. IABP was inserted preoperatively in 10 patients and intra operatively in two patients. Postoperatively all patients were extubated in 12 to 18 hours and inotropes were weaned off on the 4th or 5th postoperative day. Three patients (19%) died postoperatively due to aspiration, left ventricular failure and septic shock (one each). An insignificant residual septal defect was revealed in postoperative echocardiogram of one patient.
Conclusions: Exclusion technique for operating on patients with post infarction VSD reduced the chance of dehiscence, improving the success rate of surgery. Future studies are required to support our findings.
Keywords: acute myocardial infarction, infarct exclusion, ventricular septal rupture.
