Post-infarct ventricular septal rupture: early Impella implantation to delay surgery and reduce surgical risk.
Ventricular septal rupture (VSR) is a complication of myocardial infarction. Surgery is the only treatment; however, mortality is high, especially if it is performed within 7 days from presentation. The improved outcome with delayed intervention could be related to evolution of the infarct, which allows a more effective surgical repair. However, it is also a representation of survival bias, as an early surgery is usually performed on individuals with hemodynamic instability. We present a case of VSR complicated by cardiogenic shock. An early hemodynamic stabilization was achieved with Impella implantation; the delay in surgery allowed a reduction in surgical risk.
Interventional Cardiology Unit, San Raffaele Scientific Institute, 60 Via Olgettina, 20132, Milan, Italy. marco.ancona85@gmail.com.
Marco Bruno
MB
Ancona
Interventional Cardiology Unit, San Raffaele Scientific Institute, 60 Via Olgettina, 20132, Milan, Italy.
Damiano
D
Regazzoli
Interventional Cardiology Unit, San Raffaele Scientific Institute, 60 Via Olgettina, 20132, Milan, Italy.
Antonio
A
Mangieri
Anesthesia and Intensive Care Department, San Raffaele Scientific Institute, Milan, Italy.
Fabrizio
F
Monaco
Cardiac Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.
Michele
M
De Bonis
Interventional Cardiology Unit, San Raffaele Scientific Institute, 60 Via Olgettina, 20132, Milan, Italy.|Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
Azeem
A
Latib
D000368:Aged; D006348:Cardiac Surgical Procedures; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000601:surgery; D019919:Prosthesis Implantation; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery; D013997:Time Factors; D018658:Ventricular Septal Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*
Left ventricular assistance device; Surgical repair; Ventricular septal rupture