title: Sequential management of post-myocardial infarction ventricular septal defects.
abstract: BACKGROUND
  Ventricular septal defect (VSD) after acute myocardial infarction is a catastrophic event.
  
  
  OBJECTIVE
  We describe our multicentre experience of a defect closure strategy that combined surgery and transcatheter closure.
  
  
  METHODS
  Data were obtained by retrospective chart review.
  
  
  RESULTS
  Twenty patients (mean age, 67 years) from three centres were studied. Median time from myocardial infarction to VSD was 6 (range, 3-9) days. Acute cardiogenic shock occurred in 12 (60%) patients. Median defect diameter by echocardiography was 18 (range, 12-28) mm. Median time to first surgical or percutaneous closure was 18 (range, 4-96) days. Twenty-seven procedures were performed in the 20 patients. Surgical closure was undertaken in 14 patients and contraindicated in eight, six of whom underwent percutaneous closure; the other two, after reconsideration, proceeded to surgical closure. No procedural complications occurred with percutaneous closure. Percutaneous closure patients were older than surgical patients (75 vs. 64 years; P=0.01) and had a higher mean logistic EuroSCORE (87% vs. 67%; P=0.02). Rates of residual shunt and mortality did not differ between surgical and percutaneous patients (P=0.12 and 0.3, respectively). Those who underwent early VSD closure (<21 days after myocardial infarction) had higher rates of residual shunt (P=0.09) and mortality (P=0.01), irrespective of closure strategy. The mortality rate was also higher after early percutaneous closure (P=0.001), but not after early surgery. Finally, predicted mortality (logistic EuroSCORE) was higher than hospital mortality (≤30 days) in our patient population (75% vs. 30%; P=0.01).
  
  
  CONCLUSIONS
  Vigorous pursuit of closure of post-myocardial infarction VSD with a sequential surgical and/or percutaneous approach is recommended for improved outcomes.
authors.affiliation: Department of Pediatrics, Biological Sciences Division, The University of Chicago, Chicago, IL 60637, USA.
authors.forename: Kalyani R
authors.initials: KR
authors.lastname: Trivedi
authors.affiliation: Cardiologie Congénitale et Interventionelle, CHU la Timone, 13385 Marseille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Aldebert
authors.affiliation: Chirurgie Cardiaque, CHU la Timone, 13385 Marseille, France.
authors.forename: Alberto
authors.initials: A
authors.lastname: Riberi
authors.affiliation: Biostatistiques et Technologies de l'Information et de la Communication (BiosTIC), Hôpital de la Timone, 13385 Marseille, France; Aix Marseille Université, Inserm, IRD, UMR_S912, SESSTIM, 13385 Marseille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.affiliation: Cardiologie, Clinique le Millénaire, 34295 Montpellier, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Levy
authors.affiliation: Cardiologie, CHU Arnaud-de-Villeneuve, 34000 Montpellier, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Macia
authors.affiliation: Chirurgie Cardiaque, CHU la Timone, 13385 Marseille, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Quilicci
authors.affiliation: Chirurgie Cardiaque, CHU la Timone, 13385 Marseille, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.affiliation: Cardiologie Congénitale et Interventionelle, CHU la Timone, 13385 Marseille, France. Electronic address: alain.fraisse@ap-hm.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Fraisse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D012189:Retrospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome
keywords: Cathétérisme interventionnel; Communication interventriculaire; Fermeture chirurgicale; Infarctus du myocarde; Interventional catheterization; Myocardial infarction; Surgical closure; Ventricular septal defect