Postinfarction ventricular septal defects: towards a new treatment algorithm?
BACKGROUND
We reviewed our experience at the Montreal Heart Institute with early surgical and percutaneous closure of postinfarction ventricular septal defects (VSD).


METHODS
Between May 1995 and November 2007, 51 patients with postinfarction VSD were treated. Thirty-nine patients underwent operations, and 12 were treated with percutaneous closure of the VSD.


RESULTS
Half of the patients were in systemic shock, and 88% were supported with an intraaortic balloon pump before the procedure. Before the procedure, 14% of patients underwent primary percutaneous transluminal coronary angioplasty. The mean left ventricular ejection fraction was 0.44 +/- 0.11, and mean Qp/Qs was 2.3 +/- 1. Time from acute myocardial infarction to VSD diagnosis was 5.4 +/- 5.1 days, and the mean delay from VSD diagnosis to treatment was 4.0 +/- 4.0 days. A moderate to large residual VSD was present in 10% of patients after correction. Early overall mortality was 33%. Residual VSD, time from myocardial infarction to VSD diagnosis, and time from VSD diagnosis to treatment were the strongest predictor of mortality. Twelve patients were treated with a percutaneous occluder device, and the hospital or 30-day mortality in this group was 42%.


CONCLUSIONS
Small or medium VSDs can be treated definitively with a ventricular septal occluder or initially to stabilize patients and allow myocardial fibrosis, thus facilitating delayed subsequent surgical correction.
Maltais
Simon
S
Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
Ibrahim
Reda
R
Basmadjian
Arsène-Joseph
AJ
Carrier
Michel
M
Bouchard
Denis
D
Cartier
Raymond
R
Demers
Philippe
P
Ladouceur
Martin
M
Pellerin
Michel
M
Perrault
Louis P
LP
D000368:Aged; D000465:Algorithms; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000592:standards; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*; D019736:Prostheses and Implants