Document Type : Original Article
Authors
- Ata Firuzi 1
- Masood Shekarchizadeh 2
- Mona Yadollahi 3
- Arezoo Mohamadifar 4
- Ehsan Ferasati 5
- Mansoureh Shekarchizadeh-Esfahani 6
1 Cardiovascular Intervention Research center Rajaie Cardiovascular Medical and Research Center Iran Univesity of Medical Sceince, Tehran, Iran
2 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Rajaie Cardiovascular Medical and Research Center Iran Univesity of Medical Sceince, Tehran, Iran
4 Department of heart failure and transplantation Rajaie Cardiovascular Medical and Research Center Iran Univesity of Medical Sceince, Tehran, Iran
5 Cardiovascular Department, Kashan Univesity of Medical Sceince, Kashan, Iran
6 Internal Medicine Department,Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
INTRODUCTION: A well-known and fatal complication of myocardial infarction (MI) is post-infarction ventricular septal rupture (VSR). The benefits and risks associated with coronary angiography and subsequent coronary artery bypass grafting in these patients have sparked controversy. The aim of this study was to determine the outcome of revascularization following MI.
METHOD: Patients aged between 55 and 78 years were considered for the post-infarction ventricular septal rupture from 2011 to 2017. Factors such as age, sex, anthropometric measurements, systolic and diastolic blood pressure (SBP and DBP), and biochemical parameters like CPK-MB, cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides were measured using standard methods.
The estimated Glomerular Filtration Rate (eGFR), a measure of kidney function, was also determined. Additionally, coronary angiographic factors including ECG changes, left ventricular (LV) systolic function, right ventricular (RV) function, Pulmonary Artery Pressure (PAP), proximal coronary lesions in VSR, systolic PAP, Right Atrial Pressure (RAP), and mortality rate were determined.
RESULTS: The study enrolled a total of 81 patients who had been surgically treated for post-infarction VSR. These patients were divided into two groups: survivors (n=35) and non-survivors (N=41). The mean systolic and diastolic blood pressure was higher in the survivor group (115.3 ± 18.7 vs. 96.3 ± 25.3 and 74.6 ± 12.2 vs. 61.2 ± 19.0, P=0.001). PCI was performed in 2.9% of survivors and 9.8% of non-survivors. Angiographic data revealed that 17 (33%) and 33 (63%) patients had single and multiple coronary artery diseases, respectively. CPK-MB levels were significantly higher in the non-survivors group (P<0.05). Echocardiographic findings, including LV ejection fraction, RV ejection fraction, systolic PAP, and the anatomic location of VSR, did not significantly differ between survivors and non-survivors.
CONCLUSION: Based on these findings, it is recommended to avoid complete revascularization during surgical repair of post-infarction ventricular septal rupture, as it would not improve the outcome.
Highlights
The Google Scholar and PubMed links for Ata Firouzi
https://scholar.google.com/citations?user=CMb5kscAAAAJ&hl=en
https://pubmed.ncbi.nlm.nih.gov/?term=Firuzi+A&cauthor_id=28373791
Keywords
2. Kariyanna PT, Tadayoni A, Jayarangaiah A, Hegde S, Jayaranagaiah A, McFarlane IM. Percutaneous Closure of Post-infarction and Iatrogenic Ventricular Septal Ruptures Using Amplatzer Occluder®: A Systematic Review. Am J Med Case Rep 2021; 9(3): 184-189. https://doi.org/10.12691/ajmcr-9-3-13.
3. Bagameri G, Crestanello JA. Commentary: Belt and suspenders” or panacea: A hybrid approach to the complex problem of post myocardial infarction ventricular septal defect. JTCVS Tech 2020; 3: 204-205. https://doi.org/10.1016/j.xjtc.2020.04.013.
4. French JK, Hellkamp AS, Armstrong PW, Cohen E, Kleiman NS, O’Connor CM, et al., 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. Singh V, Rodriguez AP, Bhatt P, Alfonso C, Sakhuja R, Palacios IF, et al. Ventricular Septal Defect Complicating ST-Elevation Myocardial Infarctions: A Call for Action. Am J Med 2017; 130: 863. e1-863.e12. https://doi.org/10.1016/j.amjmed.2016.12.004
6. Shahreyar M, Akinseye O, Nayyar M, Ashraf U, Ibebuogu UN. Post-Myocardial Infarction Ventricular Septal Defect: A Comprehensive Review. Cardiovasc Revasc Med 2020; 21(11): 1444-1449. https://doi.org/10.1016/j.carrev.2018.11.017.
7. Oman Z, Kumar S, Ghani A, Sayed-Ahmad Z, Horbal P, Nasir A, et al. Percutaneous repair of post-myocardial infarction ventricular septal rupture presenting with cardiogenic shock. Am J Cardiovasc Dis 2020; 10(4): 376-381.
8. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61: e78-140.
9. Zhong W, Liu Z, Fan W, Hameed I, Salemi A, Butera G, et al., Cardiac MRI-guided interventional occlusion of ventricular septal rupture in a patient with cobalt alloy stent. Ann Transl Med 2019; 7(16): 395. https://doi.org/10.21037/atm.2019.07.55
10. Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS, et al. 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
11. Talukder QI, Rahman MH, Azad AK, Rahman MZ, Chanda PK, Ahmed F. Outcome of Surgical Repair of Post-Infarction Ventricular Septal Rupture: A Single Center Observational Study. Mymensingh Med J 2018; 27(4): 746-751. PMID: 30487489.
12. Cinq-Mars A, Voisine P, Dagenais F, Charbonneau E, Jacques F, Kalavrouziotis D, et al. Risk factors of mortality after surgical correction of ventricular septal defect following myocardial infarction: Retrospective analysis and review of the literature. Int J cardiol 2016; 206: 27-36. https://doi.org/10.1016/j.ijcard.2015.12.011
13. Huang SM, Huang SC, Wang CH, Wu IH, Chi NH, Yu HY, et al., Risk factors and outcome analysis after surgical management of ventricular septal rupture complicating acute myocardial infarction: a retrospective analysis. J Cardiothorac Surg 2015; 10: 66. https://doi.org/10.1186/s13019-015-0265-2
14. Shafiei I, Jannati F, Jannati M. Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction. J Saudi Heart Assoc 2020; 32(2): 288-294. https://doi.org/10.37616/2212-5043.1120
15. Malik J, Younus F, Malik A, Farooq MU, Kamal A, Shoaib M, Naeem H, Rana G, Rana AS, Usman M, Khalil S. One-year outcome and survival analysis of deferred ventricular septal repair in cardiogenic shock supported with mechanical circulatory support. PLoS One 2021; 16(8): e0256377. https://doi.org/10.1371/journal.pone.0256377
16. Dawson AG, Williams SG, Cole D. Does the placement of an Amplatzer septal occluder device confer benefit in patients with a post-infarction ventricular septal defect? Interact Cardiovasc Thorac Surg 2014; 19(6): 1040-7. https://doi.org/10.1093/icvts/ivu293
17. Mahmoud O, Elias H, Rafiq A, Alsaid A. Acquired aortopulmonary fistula: a case report. Eur Heart J Case Rep 2020; 4(4): 1-5. https://doi.org/10.1093/ehjcr/ytaa155
18. Takahashi H, Arif R, Almashhoor A, Ruhparwar A, Karck M, Kallenbach K. Long-term results after surgical treatment of postinfarction ventricular septal rupture. Eur J Cardiothorac Surg 2015; 47(4): 720-4.
https://doi.org/10.1093/ejcts/ezu248
19. Schlotter F, de Waha S, Eitel I, Desch S, Fuernau G, Thiele H. Interventional post-myocardial infarction ventricular septal defect closure: a systematic review of current evidence. EuroIntervention 2016; 12(1): 94-102. https://doi.org/10.4244/EIJV12I1A17
20. Petrov IS, Stankov ZI, Boychev DB, Samardjieva M. Endovascular closure of MINOCA-caused ventricular septal defect (VSD). BMJ Case Rep 2021; 14(9): e242303. https://doi.org/10.1136/bcr-2021-242303
21. Shafiei I, Jannati F, Jannati MJ. Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction. Saudi Heart Assoc 2020; 32(2): 288-294. https://doi.org/10.37616/2212-5043.1120
22. Biersteker TE, Boogers MJ, de Lind van Wijngaarden RA, Groenwold RH, Trines SA, van Alem AP, Kirchhof CJ, van Hof N, Klautz RJ, Schalij MJ, Treskes RW. Use of Smart Technology for the Early Diagnosis of Complications After Cardiac Surgery: The Box 2.0 Study Protocol. JMIR Res Protoc 2020; 9(4): e16326. https://doi.org/10.2196/16326