Tactics of Managing Postinfarction Interventricular Septal Rupture

Riazanov М.V., Маksimov А.L., Kordatov P.N., Vaykin V.E., Pichugin V.V., Bogush А.V., Kozina М.B., Medvedev А.P.

Key words: postinfarction interventricular septal defect; coronary bypass; prosthetic repair of cardiac valves.

2019, volume 11, issue 3, page 98.

DOI: https://doi.org/10.17691/stm2019.11.3.13

Full text

html pdf

2663

1936

The aim of the study was to develop tactics of surgical treatment of postinfarction interventricular septal (IVS) ruptures.

Materials and Methods. Eighteen patients with the diagnosis of “postinfarction interventricular septal rupture” have been examined and operated on. The majority of them were men, 14 in number (77.7%), and only 4 women (22.3%). The average age was 55.6±6.4 years. The time of hospitalization from the IVS rupture onset varied from 4 days to 3.5 months. Clinically, there was noted left ventricular (4 cases) or biventricular (14 cases) failure of different degree with edema of lower extremities and/or uni- or bilateral hydrothorax. Patients were performed intra-aortic balloon counterpulsation in order to stabilize clinical state and support hemodynamics.

Results. The assessment of the initial clinical state of the patients with postinfarction rupture of the IVS showed an extremely severe course of ischemic heart disease. Symptoms of severe heart failure (III–IV FC according to NYHA) were noted in all patients. Besides, 14 patients had angina pectoris (III–IV FC according to CCS) being evidence of a heavy damage of the coronary arterial bed. The expected mortality risk for our patients was 12.43±3.0% according to the EuroSCORE. Coronography demonstrated that the anterior descending artery (100%) and right coronary artery (62%) were the most commonly injured territories.

Our own experience and the data obtained from the literature enabled us to develop the tactics of surgical treatment of these patients.

Zhbanov I.V., Molochkov A.V., Aksel’rod B.A., Shmyrin M.M., Fedulova S.V., Shabalkin B.V. Surgical treatment of postinfarctial ruptures of interventricular septum. Khirurgiya. Zhurnal imeni N.I. Pirogova 2013; 2: 35–39.
Goyal A., Menon V. Contemporary management of post-MI ventricular septal rupture. J Am Coll Cardiol 2018.
Moreyra A.E., Huang M.S., Wilson A.C., Deng Y., Cosgrove N.M., Kostis J.B. Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction. Am J Cardiol 2010; 106(8): 1095–1100, https://doi.org/10.1016/j.amjcard.2010.06.013.
Honda S., Asaumi Y., Yamane T., Nagai T., Miyagi T., Noguchi T., Anzai T., Goto Y., Ishihara M., Nishimura K., Ogawa H., Ishibashi-Ueda H., Yasuda S. Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years. J Am Heart Assoc 2014; 3(5): e000984, https://doi.org/10.1161/jaha.114.000984.
Lundblad R., Abdelnoor M., Geiran O.R., Svennevig J.L. Surgical repair of postinfarction ventricular septal rupture: risk factors of early and late death. J Thorac Cardiovasc Surg 2009; 137(4): 862–868, https://doi.org/10.1016/j.jtcvs.2008.09.008.
Alshibaya M.M., Kovalenko O.A., Vishchipanov S.A. Surgical treatment of complicated forms of postinfarction heart aneurysm. Byulleten’ NTsSSKh im. A.N. Bakuleva RAMN 2009; 10(S6): 64.
Noguchi K., Yamaguchi A., Naito K., Yuri K., Adachi H. Short-term and long-term outcomes of postinfarction ventricular septal perforation. Gen Thorac Cardiovasc Surg 2012; 60(5): 261–267, https://doi.org/10.1007/s11748-011-0882-1.
Rabinovich R.M., Alshibaya M.M. Heart rupture: a case of successful medical treatment of acute rupture of left ventricular free wall during acute myocardial infarction with following surgical correction. Kreativnaya kardiologiya 2015; 3: 67–79.
Alshibaya M.M., Krimov K.V., Musin D.E., Cheishvili Z.M. Modified method of surgical correction of interventricular septum postinfarction. Annaly hirurgii 2008; 2: 78–80.
Sajja L.R., Mannam G.C., Gutti R.S., Goli N.R., Sompalli S., Penumatsa R.R. Postinfarction ventricular septal defect: patch repair with infarct exclusion. Asian Cardiovasc Thorac Ann 2008; 16(3): 215–220, https://doi.org/10.1016/s0022-5223(95)70054-4.
Rohn V., Spacek M., Belohlavek J., Tosovsky J. Cardiogenic shock in patient with posterior postinfarction septal rupture-successful treatment with extracorporeal membrane oxygenation (ECMO) as a ventricular assist device. J Card Surg 2009; 24(4): 435–436, https://doi.org/10.1111/j.1540-8191.2008.00710.x.