title: Transcatheter closure of post-myocardial infarction ventricular septal rupture.
abstract: BACKGROUND
  Ventricular septal rupture (VSR) after acute myocardial infarction (AMI) is a potentially lethal mechanical complication of acute coronary syndromes. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. We report our single-center experience with double-umbrella device percutaneous closure of post-AMI VSR.
  
  
  RESULTS
  In this single-center, retrospective, cohort study, patients who underwent transcatheter closure of post-AMI VSR between 1988 and 2008 at Boston Children's Hospital were included. Data were analysed according to whether the patients underwent direct percutaneous VSR closure or closure of a residual VSR after a previous surgical approach. Primary outcome was mortality rate at 30 days. Clinical predictors of primary outcome were investigated using univariate logistic regression. Thirty patients were included in the study (mean age, 67±8 years). A total of 40 closure devices were implanted. Major periprocedural complications occurred in 4 (13%) patients. Cardiogenic shock, increasing pulmonary/systemic flow ratio, and the use of the new generation (6-arm) STARFlex device all were associated with higher risk of mortality. The Model for End-Stage Liver Disease Excluding international normalized ratio (MELD-XI) score at the time of VSR closure seemed to be most strongly associated with death (odds ratio, 1.6; confidence interval, 1.1-2.2; P<0.001).
  
  
  CONCLUSIONS
  Transcatheter closure of post-AMI VSR using CardioSEAL or STARFlex devices is feasible and effective. The MELD-XI score, a marker of multiorgan dysfunction, is a promising risk stratifier in this population of patients. Early closure of post-AMI VSR is advisable before establishment of multiorgan failure.
authors: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115. USA.
authors: Gabriele Egidy
authors: GE
authors: Assenza
authors: Doff B
authors: DB
authors: McElhinney
authors: Anne Marie
authors: AM
authors: Valente
authors: Disty D
authors: DD
authors: Pearson
authors: Massimo
authors: M
authors: Volpe
authors: Giuseppe
authors: G
authors: Martucci
authors: Michael J
authors: MJ
authors: Landzberg
authors: James E
authors: JE
authors: Lock
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D012770:Shock, Cardiogenic; D016019:Survival Analysis; D018658:Ventricular Septal Rupture / Q000209:etiology / Q000401:mortality / Q000601:surgery*