title: Ventricular septal rupture complicating acute myocardial infarction: a contemporary review.
abstract: Ventricular septal rupture (VSR) after acute myocardial infarction is increasingly rare in the percutaneous coronary intervention era but mortality remains high. Prompt diagnosis is key and definitive surgery, though challenging and associated with high mortality, remains the treatment of choice. Alternatively, delaying surgery in stable patients may provide better results. Prolonged medical management is usually futile, but includes afterload reduction and intra-aortic balloon pump placement. Using full mechanical support to delay surgery is an attractive option, but data on success is limited to case reports. Finally, percutaneous VSR closure may be used as a temporizing measure to reduce shunt, or for patients in the sub-acute to chronic period whose comorbidities preclude surgical repair.
authors: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk J2-3, Cleveland, OH 44195, USA.
authors: Brandon M
authors: BM
authors: Jones
authors: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk J2-3, Cleveland, OH 44195, USA.
authors: Samir R
authors: SR
authors: Kapadia
authors: Cardiothoracic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors: Nicholas G
authors: NG
authors: Smedira
authors: Cardiothoracic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors: Michael
authors: M
authors: Robich
authors: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk J2-3, Cleveland, OH 44195, USA.
authors: E Murat
authors: EM
authors: Tuzcu
authors: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk J2-3, Cleveland, OH 44195, USA.
authors: Venu
authors: V
authors: Menon
authors: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk J2-3, Cleveland, OH 44195, USA krishna2@ccf.org.
authors: Amar
authors: A
authors: Krishnaswamy
mesh_terms: D003131:Combined Modality Therapy; D004452:Echocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications; D062645:Percutaneous Coronary Intervention / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000379:methods; D061665:Time-to-Treatment; D018658:Ventricular Septal Rupture / Q000209:etiology / Q000628:therapy*
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Acute myocardial infarction; Percutaneous closure; VSR; Ventricular septal rupture