Surgical treatment and prognosis of myocardial infarction complicated with ventricular septal perforation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Taoshuai ¹ , LIU Weiye ² , HUANG Zhuhui ¹ , ZHAO Yang ¹ , ZHENG Jubing ¹ ,  DONG Ran ¹

1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;
2. Department of Critical Care Medicine, The People's Hospital of Zhaoyuan City, Zhaoyuan, 265400, Shandong, P.R.China;

Corresponding author：

DONG Ran, Email: dongran6618@hotmail.com

Keywords：

Myocardial infarction; ventricular septal perforation; surgical repair; treatment

DOI：

10.7507/1007-4848.202006059

Video：

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Objective To investigate the surgical methods and efficacy of myocardial infarction combined with ventricular septal perforation.Methods The clinical data of 60 patients with myocardial infarction combined with ventricular septal perforation admitted to the Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, from 2009 to 2018 were retrospectively analyzed. There were 39 males and 21 females, aged 63.3±8.3 years.Results Among the 60 patients, 43 (71.7%) patients were perforated in the apex, 11 (18.3%) in the posterior septum and 6 (10.0%) in the anterior septum. There were 24 (40.0%) patients of single coronary artery disease. Fourteen (23.3%) patients received intra-aortic balloon counterpulsation before surgery. The waiting time from ventricular septal perforation to surgery was 48.3 (3-217) d. All patients underwent ventricular septal perforation repair, among whom 53 (88.3%) patients received ventricular aneurysm closure or resection, and 49 (81.7%) patients received coronary artery bypass graft with an average of 2 distal anastomoses during the same period. Perioperative complications in the hospital included 8 (13.3%) deaths, 8 (13.3%) heart failure, 5 (8.3%) ventricular fibrillation, 3 (5.0%) pericardial tamponade, and 11 (18.3%) secondary thoracotomy and 11 (18.3%) residual shunt. Except for 8 patients who died in the hospital, the other 52 cured and discharged patients were followed up. The median follow-up time was 4.9 years. The 2-year and 5-year survival rate of the patients was 95.8%, and the 8-year survival rate was 89.0%. Major adverse cardiovascular events incidence was 19.2%, including 3 (5.8%) deaths, 5 (9.6%) heart failure, 2 (3.8%) myocardial infarction, and 4 (7.7%) cerebrovascular events.Conclusion For patients with ventricular septal perforation after myocardial infarction, surgery is an effective treatment method. Although the perioperative mortality rate is high, satisfactory long-term results can be achieved by carefully choosing the operation timing and methods.

Citation： LIU Taoshuai, LIU Weiye, HUANG Zhuhui, ZHAO Yang, ZHENG Jubing, DONG Ran. Surgical treatment and prognosis of myocardial infarction complicated with ventricular septal perforation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(9): 1061-1065. doi: 10.7507/1007-4848.202006059 Copy

1.	Birnbaum Y, Fishbein MC, Blanche C, et al. Ventricular septal rupture after acute myocardial infarction. N Engl J Med, 2002, 347(18): 1426-1432.
2.	Radford MJ, Johnson RA, Daggett WM, et al. Ventricular septal rupture: A review of clinical and physiologic features and an analysis of survival. Circulation, 1981, 64(3): 545-553.
3.	Durko AP, Budde RPJ, Geleijnse ML, et al. Recognition, assessment and management of the mechanical complications of acute myocardial infarction. Heart, 2018, 104(14): 1216-1223.
4.	Jones BM, Kapadia SR, Smedira NG, et al. Ventricular septal rupture complicating acute myocardial infarction: A contemporary review. Eur Heart J, 2014, 35(31): 2060-2068.
5.	Hartikainen TS, Sörensen NA, Haller PM, et al. Clinical application of the 4th Universal Definition of Myocardial Infarction. Eur Heart J, 2020, 41(23): 2209-2216.
6.	Wilson WM, Horlick EM. Management of post-myocardial infarction ventricular septal rupture. EuroIntervention, 2016, 12(Suppl X): X18-X23.
7.	Isoda S, Osako M, Kimura T, et al. Surgical repair of postinfarction ventricular septal defects-2013 update. Ann Thorac Cardiovasc Surg, 2013, 19(2): 95-102.
8.	Poulsen SH, Praestholm M, Munk K, et al. Ventricular septal rupture complicating acute myocardial infarction: Clinical characteristics and contemporary outcome. Ann Thorac Surg, 2008, 85(5): 1591-1596.
9.	Schlotter F, de Waha S, Eitel I, et al. Interventional post-myocardial infarction ventricular septal defect closure: A systematic review of current evidence. EuroIntervention, 2016, 12(1): 94-102.
10.	Serpytis P, Karvelyte N, Serpytis R, et al. Post-infarction ventricular septal defect: Risk factors and early outcomes. Hellenic J Cardiol, 2015, 56(1): 66-71.
11.	Cinq-Mars A, Voisine P, Dagenais F, 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.
12.	Asai T. Postinfarction ventricular septal rupture: Can we improve clinical outcome of surgical repair? Gen Thorac Cardiovasc Surg, 2016, 64(3): 121-130.
13.	Martin WA, Sigwart U. Who and how to treat with non-surgical myocardial reduction therapy in hypertrophic cardiomyopathy: Long-term outcomes. Heart Fail Monit, 2002, 3(1): 15-27.
14.	Baldasare MD, Polyakov M, Laub GW, et al. Percutaneous repair of post-myocardial infarction ventricular septal defect: Current approaches and future perspectives. Tex Heart Inst J, 2014, 41(6): 613-619.
15.	Heiberg J, Hjortdal VE, Nielsen-Kudsk JE. Long-term outcome after transcatheter closure of postinfarction ventricular septal rupture. J Interv Cardiol, 2014, 27(5): 509-515.
16.	Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). J Am Coll Cardiol, 2004, 44(3): 671-719.
17.	李汉美, 项理, 许建屏, 等. 急性心肌梗死后合并室间隔穿孔外科修复 105 例: 阜外医院 16 年随访结果. 中国胸心血管外科临床杂志, 2019, 26(5): 451-456.

1. Birnbaum Y, Fishbein MC, Blanche C, et al. Ventricular septal rupture after acute myocardial infarction. N Engl J Med, 2002, 347(18): 1426-1432.
2. Radford MJ, Johnson RA, Daggett WM, et al. Ventricular septal rupture: A review of clinical and physiologic features and an analysis of survival. Circulation, 1981, 64(3): 545-553.
3. Durko AP, Budde RPJ, Geleijnse ML, et al. Recognition, assessment and management of the mechanical complications of acute myocardial infarction. Heart, 2018, 104(14): 1216-1223.
4. Jones BM, Kapadia SR, Smedira NG, et al. Ventricular septal rupture complicating acute myocardial infarction: A contemporary review. Eur Heart J, 2014, 35(31): 2060-2068.
5. Hartikainen TS, Sörensen NA, Haller PM, et al. Clinical application of the 4th Universal Definition of Myocardial Infarction. Eur Heart J, 2020, 41(23): 2209-2216.
6. Wilson WM, Horlick EM. Management of post-myocardial infarction ventricular septal rupture. EuroIntervention, 2016, 12(Suppl X): X18-X23.
7. Isoda S, Osako M, Kimura T, et al. Surgical repair of postinfarction ventricular septal defects-2013 update. Ann Thorac Cardiovasc Surg, 2013, 19(2): 95-102.
8. Poulsen SH, Praestholm M, Munk K, et al. Ventricular septal rupture complicating acute myocardial infarction: Clinical characteristics and contemporary outcome. Ann Thorac Surg, 2008, 85(5): 1591-1596.
9. Schlotter F, de Waha S, Eitel I, et al. Interventional post-myocardial infarction ventricular septal defect closure: A systematic review of current evidence. EuroIntervention, 2016, 12(1): 94-102.
10. Serpytis P, Karvelyte N, Serpytis R, et al. Post-infarction ventricular septal defect: Risk factors and early outcomes. Hellenic J Cardiol, 2015, 56(1): 66-71.
11. Cinq-Mars A, Voisine P, Dagenais F, 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.
12. Asai T. Postinfarction ventricular septal rupture: Can we improve clinical outcome of surgical repair? Gen Thorac Cardiovasc Surg, 2016, 64(3): 121-130.
13. Martin WA, Sigwart U. Who and how to treat with non-surgical myocardial reduction therapy in hypertrophic cardiomyopathy: Long-term outcomes. Heart Fail Monit, 2002, 3(1): 15-27.
14. Baldasare MD, Polyakov M, Laub GW, et al. Percutaneous repair of post-myocardial infarction ventricular septal defect: Current approaches and future perspectives. Tex Heart Inst J, 2014, 41(6): 613-619.
15. Heiberg J, Hjortdal VE, Nielsen-Kudsk JE. Long-term outcome after transcatheter closure of postinfarction ventricular septal rupture. J Interv Cardiol, 2014, 27(5): 509-515.
16. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). J Am Coll Cardiol, 2004, 44(3): 671-719.
17. 李汉美, 项理, 许建屏, 等. 急性心肌梗死后合并室间隔穿孔外科修复 105 例: 阜外医院 16 年随访结果. 中国胸心血管外科临床杂志, 2019, 26(5): 451-456.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment and prognosis of myocardial infarction complicated with ventricular septal perforation

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