Epidemiology of Post-Infarction Ventricular Septal Rupture in Patients Undergoing Surgical Repair at Different Times from the Development of Acute Myocardial Infarction

DOI: https://doi.org/10.30702/ujcvs/21.4512/AL047-1825
Keywords: mechanical complications of acute myocardial infarction, atherosclerosis of the coronary arteries, ischemic heart disease, reperfusion of coronary arteries, surgical treatment of ischemic heart disease, coronary artery bypass grafting

Abstract

Introduction. The article is dedicated to the epidemiological aspects of the mechanical complication of acute myocardial infarction (AMI), particularly post-infarction ventricular septal rupture (VSR), problematic issues of its etiology and localization. Mortality of such patients is determined by rapid development of hemodynamic disorders and their severity, unpredictable clinical course, and the difficulty of early diagnosis. In addition, the high mortality rate of patients, especially when correcting the ventricular septal defect at the early stages after AMI, leaves open the question of the tactics of surgical treatment. The influence of certain risk factors of ischemic heart disease (IHD) on the development of post-infarction VSR is also considered.

The aim. To study the epidemic features of post-infarction VSR in patients with different terms of surgical intervention after the development of AMI.

Materials and methods. This study presents a retrospective analysis of 90 patients with coronary artery disease complicated by post-infarction VSR, who underwent surgical intervention for the period 2002-2019. The ages of hospitalized patients with post-infarction VSR ranged from 29 to 81 years. All the patients were divided into 3 groups depending on the time interval from AMI to surgical intervention.

Results and discussion. It was found that post-infarction VSR is more common in men in the age range of 45-74 years after the manifestation of the first transmural AMI. More than a half of post-infarction VSR cases (56.7%) are associated with anterior localization of the ruptures in consequence of anterior AMI. Since the leading role in the treatment of AMI belongs to percutaneous coronary interventions (PCI), we analyzed the use of various reperfusion techniques to restore coronary blood flow in patients with post-infarction VSR. The analysis suggests that there are no statistically significant differences between the studied groups of patients with post-infarction VSR who underwent myocardial reperfusion (p = 0.103).

Conclusions. The presence of chronic renal failure (CRF) in patients in the early post-infarction period can complicate the course of post-infarction VSR and affect perihospital mortality. The absence or untimeliness of myocardial reperfusion increases the risk of developing this complication of AMI. The ambiguous prognosis of treatment of post-infarction VSR makes a serious problem for clinicians.

References

  1. Khan MY, Waqar T, Qaisrani PG, Khan AZ, Khan MS, Zaman H, Jalal A. Surgical Repair of post-infarction ventricular septal rupture: Determinants of operative mortality and survival outcome analysis. Pak J Med Sci. 2018;34(1):20-26. https://doi.org/10.12669/pjms.341.13906
  2. Maltais S, Ibrahim R, Basmadjian AJ, Carrier M, Bouchard D, Cartier R, Demers P, Ladouceur M, Pellerin M, Perrault LP. Postinfarction Ventricular Septal Defects: Towards a New Treatment Algorithm? Ann Thorac Surg. 2009;87(3):687-93. https://doi.org/10.1016/j.athoracsur.2008.11.052
  3. Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS, Vahanian A, Califf RM, Topol EJ. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation. 2000;101(1):27-32. https://doi.org/10.1161/01.cir.101.1.27
  4. French JK, Hellkamp AS, Armstrong PW, Cohen E, Kleiman NS, O’Connor CM, Holmes DR, Hochman JS, Granger CB, Mahaffey KW. Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI). Am J Cardiol. 2010;105(1):59-63. https://doi.org/10.1016/j.amjcard.2009.08.653
  5. Moreyra AE, Huang MS, Wilson AC, Deng Y, Cosgrove NM, Kostis JB; MIDAS Study Group (MIDAS 13). Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction.Am J Cardiol. 2010;106(8):1095-100. https://doi.org/10.1016/j.amjcard.2010.06.013
  6. Alshibaya MM, Kovalenko OA, Vishchipanov SA. [Surgical treatment of complicated forms of postinfarction heart aneurysm] [abstract]. Bulletin A.N. Bakuleva RAMS. 2009;10(S6):64. Russian.
  7. Cummings RG, Califf R, Jones RN, Reimer KA, Kong YH, Lowe JE. Correlates of survival in patients with postinfarction ventricular septal defect. Ann Thorac Surg. 1989;47(6):824-30. https://doi.org/10.1016/0003-4975(89)90012-X
  8. Menon V, Webb JG, Hillis LD, Sleeper LA, Abboud R, Dzavik V, Slater JN, Forman R, Monrad ES, Talley JD, Hochman JS. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? J Am Coll Cardiol. 2000;36(3 Suppl A):1110-6. https://doi.org/10.1016/s0735-1097(00)00878-0
  9. Cummings RG, Reimer KA, Califf R, Hackel D, Boswick J, Lowe JE. Quantitative analysis of right and left ventricular infarction in the presence of postinfarction ventricular septal defect. Circulation. 1988;77(1):33-42. https://doi.org/10.1161/01.cir.77.1.33
  10. David TE, Dale L, Sun Z. Postinfarction ventricular septal rupture: repair by endocardial patch with infarct exclusion. J Thorac Cardiovasc Surg. 1995;110(5):1315-22. https://doi.org/10.1016/S0022-5223(95)70054-4
  11. Prêtre R, Ye Q, Grünenfelder J, Zund G, Turina MI. Role of MyocardialRevascularizationinPostinfarctionVentricular Septal Rupture. Ann Thorac Surg. 2000;69(1):51-5. https://doi.org/10.1016/s0003-4975(99)00857-7
  12. Arnaoutakis GJ, Zhao Y, George TJ, Sciortino CM, McCarthy PM, Conte JV. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2012;94(2):436-43. https://doi.org/10.1016/j.athoracsur.2012.04.020
  13. Belov YuV, Varaksin VA. [Modern understanding of postinfarction left ventricular remodeling]. Cardiology. 2002;(10):469-71. Russian.
  14. Belov YuV, Charchyan ER, Kizima AG. [Surgical treatment of postinfarction ventricular septal defect]. Cardiology and Cardiovascular Surgery. 2007;(1):54-63. Russian.
  15. Poulsen SH, Praestholm M, Munk K, Wierup P, Egeblad H, Nielsen-Kudsk JE. Ventricular septal rupture complicating acute myocardial infarction: clinical characteristics and contemporary outcome. Ann Thorac Surg. 2008;85(5):1591-6. https://doi.org/10.1016/j.athoracsur.2008.01.010
  16. Papadopoulos N, Moritz A, Dzemali O, Zierer A, Rouhollapour A, Ackermann H, Bakhtiary F. Long-term results after surgical repair of postinfarction ventricularseptal rupture by infarct exclusion technique. Ann Thorac Surg. 2009;87(5):1421-5. https://doi.org/10.1016/j.athoracsur.2009.02.011
  17. Jones BM, Kapadia SR, Smedira NG, Robich M, Tuzcu EM, Menon V, Krishnaswamy A. Ventricular septal rupture complicating acute myocardial infarction: a contemporary review. Eur Heart J. 2014;35(31):2060-8. https://doi.org/10.1093/eurheartj/ehu248
  18. Volkov VI, Strona VI. Gendernye i vozrastnye osobennosti ishemicheskoy bolezni serdtsa [Gender and age characteristics of coronary heart disease]. Zdorovia Ukrainy. 2007;12 (1):33-35. Ukrainian.
  19. Moreno R, López-Sendón J, García E, Pérez de Isla L, López de Sá E, Ortega A, Moreno M, Rubio R, Soriano J, Abeytua M, García-Fernández MA. Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction. J Am Coll Cardiol. 2002;39(4):598-603. https://doi.org/10.1016/s0735-1097(01)01796-x
  20. Parkhomenko AN, Irkin OI, Lutay YaM, Vovchenko VYe, Kushnir SP. [Case of successful diagnosis and treatment of left ventricular pseudoaneurysm in acute myocardial infarction]. Medyt︠s︡yna nevidkladnykh staniv. 2014;(3(58)):97-100. Ukrainian. https://doi.org/10.22141/2224-0586.3.58.2014.83280
  21. Ursulenko VI, Rudenko AV, Zakharova VP, Beregovoi AA, Panichkin YuV, Jacob LV, Rudenko NL, Cherpak BV, Ditkovskiy IA, Dzahoyeva LS. [Postinfarction interventricular septum ruptures: incidence and results of surgical treatment]. Heart & Vessels. 2014;(2(46)):16-27. Ukrainian.
  22. Hutchins GM. Rupture of the interventricular septum complicating myocardial infarction: pathological analysis of 10 patients with clinically diagnosed perforations. Am Heart J. 1979;97(2):165-73. https://doi.org/10.1016/0002-8703(79)90351-x
  23. Yip HK, Fang CY, Tsai KT, Chang HW, Yeh KH, Fu M, Wu CJ. The potential impact of primary percutaneous coronary intervention on ventricular septal rupture complicating acute myocardial infarction. Chest. 2004;125(5):1622-8. https://doi.org/10.1378/chest.125.5.1622
  24. Hill JD, Stiles QR. Acute ischemic ventricular septal defect. Circulation. 1989;79(6 Pt 2):I112-5. PMID: 2655970.
  25. Xu XD, Liu SX, Liu X, Chen Y, Li L, Qu BM, Wu ZY, Zhang DF, Zhao XX, Qin YW. Percutaneous closure of postinfarct muscular ventricular septal defects: a multicenter study in China. J Cardiol. 2014;64(4):285-9. https://doi.org/10.1016/j.jjcc.2014.02.006
  26. Edwards BS, Edwards WD, Edwards JE. Ventricular septal rupture complicating acute myocardial infarction: identification of simple and complex types in 53 autopsied hearts. Am J Cardiol. 1984;54(10):1201-5. https://doi.org/10.1016/s0002-9149(84)80067-3
  27. Birnbaum Y, Fishbein MC, Blanche C, Siegel RJ. Ventricular septal rupture after acute myocardial infarction. N Engl J Med. 2002;347(18):1426-32. https://doi.org/10.1056/NEJMra020228
  28. Rudenko ML. [Diagnostics and treatment of postinfarction defect of the midshlunochkovy septum] [dissertation]. Kyiv:Amosov National Institute of Cardiovascular Surgery; 2017. Ukrainian.
Published
2021-12-22
How to Cite
Aliyev, R. A., Lebedieva, Y. O., Grusha, M. M., & Musayev, K. K. (2021). Epidemiology of Post-Infarction Ventricular Septal Rupture in Patients Undergoing Surgical Repair at Different Times from the Development of Acute Myocardial Infarction. Ukrainian Journal of Cardiovascular Surgery, (4 (45), 18-25. https://doi.org/10.30702/ujcvs/21.4512/AL047-1825
Issue
Ukrainian Journal of Cardiovascular Surgery No 4 (45) 2021
Section
ISCHEMIC HEART DISEASE