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Post-infarction ventricular septal rupture: A review of cases at the Philippine Heart Center.

Author

Patricio P. Palmes,
Romeo J. Santos,
Cesar K. Ho,
James K. Ho,
Gerardo S. Manzo

Related Institution

Publication Information

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Journal of Cardiology
Frequency
Quarterly
Publication Date
October-December 1997
Volume
25
Issue
4
Page(s)
179-188

Abstract

OBJECTIVES. To review cases of post-infarction ventricular septal rupture admitted at the Philippine Heart Center, explore the associated risk factors; evaluate the approaches in the diagnosis and management; and determine the outcome.


METHODS. Seven acute myocardial infarction (MI) patients (2 males and 5 females) with a mean age of 65 years (range:54-74 years old) who developed post-infarction ventricular septal defect (VSD) or rupture were retrospectively studied.


RESULTS. All 7 patients had extensive anterior wall MI with the additional involvement of the inferior wall in 3 patients. They all presented with a holosystolic murmur about a week (range: 2-18 days) after acute MI and functional class III-IV with 86% (6/7) of them having cardiogenic shock. Two-dimensional echocardiographic and doppler (2-DED) study rapidly confirmed the presence of post-infarction VSD in all patients. Five (71%) of them underwent hemodynamic studies (HS) and coronary angiogram (CA) with insertion of intra-aortic balloon pump (ISBP) in 3 patients. These 5 patients were subsequently subjected to early VSD repair and aorto-coronary bypass (ACB) about 2 weeks (range: 2-20 days) after MI. Three out of five (60%) patients who were operated survived while all patients who were managed medically died eary of cardiogenic shock. Two operated patients died because of pulmonary embolism and acute respiratory distress syndrome (ARDS).


CONCLUSION. Early diagnosis, immediate institution of pharmacologic and mechanical support (IABP) as necessary, cardiac catheterization and coronary angiogram if hemodynamic status allows, and urgent surgical management may improve patient survival in post-infarction VSD.

References

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