Percutaneous closure of post myocardial infarction ventricular septal rupture
Written By : Dr. Nandita Mohan
Medically Reviewed By : Dr. Kamal Kant Kohli
Published On 2022-09-07 03:45 GMT | Update On 2022-09-07 03:45 GMT
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The incidence of post-infarction ventricular septum rupture has decreased from 1–2% to 0.25–0.31%. Survival up to 1 month without intervention is 6%. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases.
Indian data on percutaneous device closure is scarce hence they report in single-center experience with ASD occlude device for closure of post- acute myocardial infarction ventricular septum rupture. The Study is published in Indian Heart Journal.
In the single-center, retrospective, cohort study, patients who underwent transcatheter closure of post-myocardial infarction ventricular septum rupture were included. Primary outcome was mortality rate at 30 days.
Seven patients were included, out pf which 5 patients had anterior wall myocardial infarction (AWMI) & 2 had inferior wall myocardial infarction (IWMI). None of the patients received thrombolytic therapy.
Device was successfully placed in 5 patients (71.4%) with minimal residual shunt in 2 patients (40%). Out of 7 cases 2 patients survived (29% survival rate). Cardiogenic shock, inferior wall myocardial infarction and serpiginous form of ventricular septum rupture were associated with poor outcomes. Delayed revascularization (PCI) was associated with better outcomes.
Percutaneous closure is a potential technique in a selected group of patients. The presence of cardiogenic shock, inferior wall myocardial infarction and serpiginous form of ventricular septum rupture constitutes important risk factors for mortality. Device implantation is in general successful with few procedure-related complications and should be applied on a case-by-case basis.
Reference: Premchand RK, Garipalli R, Padmanabhan TN, Manik G. Percutaneous closure of post-myocardial infarction ventricular septal rupture - A single centre experience. Indian Heart J. 2017 Apr;69 Suppl 1(Suppl 1):S24-S27. doi: 10.1016/j.ihj.2016.10.004. Epub 2016 Nov 1. PMID: 28400035; PMCID: PMC5388014.
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