Ventricular Septal Rupture (Defect), Postmyocardial Infarction


Risk

  • Historically seen in 1–3% of MIs prior to era of acute revascularization.

  • Incidence is 0.2% in current era of acute percutaneous intervention.

  • Most occur within 1 wk of MI; 20–30% occur in first 24 h post-MI.

  • Rarely occurs >2 wk post-MI.

  • Medical management alone results in a mortality >90%.

Perioperative Risks

  • Accounts for 5% of MI-related deaths,

  • Without surgical therapy, survival is less than 10% at 1 mo.

  • Surgical short-term survival 40–81%.

  • Increased mortality seen in the setting of urgent repair (due to tissue fragility), posterior VSD, preop dialysis, mitral regurgitation, and redo cardiac surgery.

  • Improvements in surgical techniques have enabled earlier surgery prior to hemodynamic deterioration, with associated increase in survival.

  • Percutaneous device closure with GA and TEE has similar mortality.

Worry About

  • Associated papillary muscle rupture

  • Poor systemic perfusion and end-organ dysfunction

  • Pulm congestion with massive L-to-R shunt

Overview

  • Sudden onset of holosystolic murmur with thrill and hemodynamic deterioration (hypotension and pulm congestion).

  • Despite advances in periop management, expect increased morbidity and mortality.

  • Expect a complicated postop course with prolonged ICU stay.

Usual Treatment

  • Repair of new VSD with hemodynamic deterioration using pericardial or prosthetic patch material.

  • Support preop with inotropic agents/intra-aortic balloon counterpulsation.

  • Percutaneous device closure as an alternative to surgery.

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