Abstract

Research Article

Percutaneous Closure of Post-myocardial Infarction Ventricular Septal Rupture-experience From a Resource-limited Setup From Eastern Part of India

Siddhartha Saha*

Published: 20 June, 2024 | Volume 9 - Issue 2 | Pages: 087-092

Background: Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of an acute myocardial infarction (AMI). It results in 90% - 95% mortality within two months of diagnosis without any kind of intervention. Given high surgical mortality, transcatheter closure has emerged as a potential strategy as an alternative to high-risk surgical closure. Indian data on percutaneous device closure of post-AMI-VSR is limited hence we report our resource-limited single-centre experience with different kinds of occluder devices for closure of post-AMI VSR.
Methods and results: In this single-centre, retrospective, cohort study, patients who underwent transcatheter closure of post-MI VSR between 2018 and 2024 at Health World hospitals, in Durgapur, West Bengal, were included. The primary outcome was a mortality rate of 30 days. The study population was eleven primary cases of post-MI VSR. The mean age of the population was 61 years. The majority of the patients had anterior wall MI (54.5%) and the remaining had inferior wall MI.  Different kinds of devices (ASO, PostMI VSD device, Konar MFO) were used to close VSR. Successful closure was performed in 9 patients (81%) with minimal residual shunt in 2 patients. Out of 9 cases 3 patients expired, one was lost to follow up and the rest are doing well at 30 days follow-up. 
Conclusion: Transcatheter closure of PMIVSRs can be performed with different kinds of devices with high technical success, relatively low procedural complication rates, and 30 days survival even in a resource-limited setup as an alternative to high-risk surgical closure.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001184 Cite this Article Read Full Article PDF

Keywords:

Myocardial infarction; Surgical repair; Transcatheter closure; Ventricular septal rupture

References

  1. Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS, Vahanian A, Califf RM, Topol EJ. 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 Jan 4-11;101(1):27-32. doi: 10.1161/01.cir.101.1.27. PMID: 10618300.
  2. Figueras J, Alcalde O, Barrabés JA, Serra V, Alguersuari J, Cortadellas J, Lidón RM. Changes in hospital mortality rates in 425 patients with acute ST-elevation myocardial infarction and cardiac rupture over a 30-year period. Circulation. 2008 Dec 16;118(25):2783-9. doi: 10.1161/CIRCULATIONAHA.108.776690. Epub 2008 Dec 8. PMID: 19064683.
  3. Menon V, Webb JG, Hillis LD, Sleeper LA, Abboud R, Dzavik V, Slater JN, Forman R, Monrad ES, Talley JD, Hochman JS. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? J Am Coll Cardiol. 2000 Sep;36(3 Suppl A):1110-6. doi: 10.1016/s0735-1097(00)00878-0. PMID: 10985713.
  4. Papadopoulos N, Moritz A, Dzemali O, Zierer A, Rouhollapour A, Ackermann H, Bakhtiary F. Long-term results after surgical repair of postinfarction ventricular septal rupture by infarct exclusion technique. Ann Thorac Surg. 2009 May;87(5):1421-5. doi: 10.1016/j.athoracsur.2009.02.011. PMID: 19379878.
  5. Deville C, Fontan F, Chevalier JM, Madonna F, Ebner A, Besse P. Surgery of post-infarction ventricular septal defect: risk factors for hospital death and long-term results. Eur J Cardiothorac Surg. 1991;5(4):167-74; discussion 175. doi: 10.1016/1010-7940(91)90026-g. PMID: 2059449.
  6. Arnaoutakis GJ, Zhao Y, George TJ, Sciortino CM, McCarthy PM, Conte JV. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2012 Aug;94(2):436-43; discussion 443-4. doi: 10.1016/j.athoracsur.2012.04.020. Epub 2012 May 23. PMID: 22626761; PMCID: PMC3608099.
  7. Deja MA, Szostek J, Widenka K, Szafron B, Spyt TJ, Hickey MS, Sosnowski AW. Post infarction ventricular septal defect - can we do better? Eur J Cardiothorac Surg. 2000 Aug;18(2):194-201. doi: 10.1016/s1010-7940(00)00482-6. PMID: 10925229.
  8. Xu XD, Liu SX, Liu X, Chen Y, Li L, Qu BM, Wu ZY, Zhang DF, Zhao XX, Qin YW. Percutaneous closure of postinfarct muscular ventricular septal defects: a multicenter study in China. J Cardiol. 2014 Oct;64(4):285-9. doi: 10.1016/j.jjcc.2014.02.006. Epub 2014 Mar 24. PMID: 24674748.
  9. Landzberg MJ, Lock JE. Transcatheter management of ventricular septal rupture after myocardial infarction. Semin Thorac Cardiovasc Surg. 1998 Apr;10(2):128-32. doi: 10.1016/s1043-0679(98)70006-1. PMID: 9620460.
  10. Calvert PA, Cockburn J, Wynne D, Ludman P, Rana BS, Northridge D, Mullen MJ, Malik I, Turner M, Khogali S, Veldtman GR, Been M, Butler R, Thomson J, Byrne J, MacCarthy P, Morrison L, Shapiro LM, Bridgewater B, de Giovanni J, Hildick-Smith D. Percutaneous closure of postinfarction ventricular septal defect: in-hospital outcomes and long-term follow-up of UK experience. Circulation. 2014 Jun 10;129(23):2395-402. doi: 10.1161/CIRCULATIONAHA.113.005839. Epub 2014 Mar 25. PMID: 24668286.
  11. Menon V, Fincke R. Cardiogenic shock: a summary of the randomized SHOCK trial. Congest Heart Fail. 2003 Jan-Feb;9(1):35-9. doi: 10.1111/j.1751-7133.2003.tb00020.x. PMID: 12556676.
  12. Holzer R, Balzer D, Amin Z, Ruiz CE, Feinstein J, Bass J, Vance M, Cao QL, Hijazi ZM. Transcatheter closure of postinfarction ventricular septal defects using the new Amplatzer muscular VSD occluder: Results of a U.S. Registry. Catheter Cardiovasc Interv. 2004 Feb;61(2):196-201. doi: 10.1002/ccd.10784. PMID: 14755811.
  13. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999 Aug 26;341(9):625-34. doi: 10.1056/NEJM199908263410901. PMID: 10460813.
  14. Thiele H, de Waha S. Expert consensus on how should we treat VSDs and acute MR post MI? [Internet]. American College of Cardiology; c2015 [cited 2024 Jun 20]. http://www.acc.org/latest-in-cardiology/articles/2015/06/11/10/57/how-should-we-treat-vsds-and-acute-mr-post-mi?w_nav=TI.doi: 10.1016/j.ihj.2016.10.004
  15. Thiele H, Kaulfersch C, Daehnert I, Schoenauer M, Eitel I, Borger M, Schuler G. Immediate primary transcatheter closure of postinfarction ventricular septal defects. Eur Heart J. 2009 Jan;30(1):81-8. doi: 10.1093/eurheartj/ehn524. Epub 2008 Nov 25. PMID: 19036747.
  16. Moore CA, Nygaard TW, Kaiser DL, Cooper AA, Gibson RS. Postinfarction ventricular septal rupture: the importance of location of infarction and right ventricular function in determining survival. Circulation. 1986 Jul;74(1):45-55. doi: 10.1161/01.cir.74.1.45. PMID: 3708777.
  17. Maltais S, Ibrahim R, Basmadjian AJ, Carrier M, Bouchard D, Cartier R, Demers P, Ladouceur M, Pellerin M, Perrault LP. Postinfarction ventricular septal defects: towards a new treatment algorithm? Ann Thorac Surg. 2009 Mar;87(3):687-92. doi: 10.1016/j.athoracsur.2008.11.052. PMID: 19231370.
  18. Kamran MM, Gopi A, Lakhani Z, Shaik A, Musthafa J, Raghuram G, Musthafa PPM. Utility of Konar-Multifunctional Occluder in Complex Situations: Unconventional Uses in Rare Situations. Pediatr Cardiol. 2024 Jan;45(1):121-132. doi: 10.1007/s00246-023-03358-9. Epub 2023 Dec 16. PMID: 38103070.

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