title: Post-infarction ventricular septal defect: risk factors and early outcomes.
abstract: BACKGROUND
  Rupture of the ventricular septum complicates acute myocardial infarction in 0.2% of cases in the thrombolytic era. Ventricular septal defect (VSD) has a mortality of 90-95% in medically managed and 19-60% in surgically treated patients.
  
  
  METHODS
  A retrospective analysis was performed of 41 patients, 26 females (63.4%) and 15 males (36.6%), average age 67.5 ± 15 years, with post-infarction VSD who were treated in the VUL SK intensive cardiology unit between 1991 and 2007.
  
  
  RESULTS
  Thirty-seven patients had hypertension (90.2%); anterior wall acute myocardial infarction (AMI) was found in 27 patients (68%). VSD was more frequent in women than in men (p=0.043). In 36 patients (87%) treatment was started 24 hours or later after the development of AMI symptoms. In 34 patients (83%) the rupture occurred during the first episode of AMI and in the majority of these (19 patients, 46.3%), preoperative coronary angiography demonstrated disease of only one coronary artery. During the first 10 days after the onset of AMI, 5 patients (12.2%) were treated surgically but did not survive the operation; 33 patients (80.5%) underwent operation 3-4 weeks after the onset of AMI and all survived.
  
  
  CONCLUSIONS
  Female sex, advanced age, arterial hypertension, anterior wall AMI, absence of previous AMI, and late arrival at hospital are associated with a higher risk of mortality from acute VSD. The most important factor that determines operative mortality and intra-hospital survival is the time from the onset of AMI to operation.
authors.affiliation: Cardiology and Angiology Center, Vilnius University, Vilnius, Lithuania.
authors.forename: Pranas
authors.initials: P
authors.lastname: Serpytis
authors.forename: Neringa
authors.initials: N
authors.lastname: Karvelyte
authors.forename: Rokas
authors.initials: R
authors.lastname: Serpytis
authors.forename: Gintaras
authors.initials: G
authors.lastname: Kalinauskas
authors.forename: Kestutis
authors.initials: K
authors.lastname: Rucinskas
authors.forename: Robertas
authors.initials: R
authors.lastname: Samalavicius
authors.forename: Justinas
authors.initials: J
authors.lastname: Ivaska
authors.forename: Sigita
authors.initials: S
authors.lastname: Glaveckaite
authors.forename: Egidijus
authors.initials: E
authors.lastname: Berukstis
authors.forename: Marco
authors.initials: M
authors.lastname: Tubaro
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Alpert
authors.forename: Aleksandras
authors.initials: A
authors.lastname: Laucevičius
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D056988:Anterior Wall Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013300:Streptokinase / Q000008:administration & dosage / Q000009:adverse effects; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods; D061665:Time-to-Treatment; D018658:Ventricular Septal Rupture / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase