title: Percutaneous closure of post-myocardial infarction ventricular septal rupture - A single centre experience.
abstract: BACKGROUND
  Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of an acute myocardial infarction (AMI). Survival to 1 month without intervention is 6%. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. Indian data on percutaneous device closure of post AMI-VSR is scarce hence we report our single-centre experience with ASD occluder device (Amplatzer and lifetech) for closure of post-AMI VSR.
  
  
  RESULTS
  In this single-centre, retrospective, cohort study, patients who underwent transcatheter closure of post-MI VSR between 2005 and 2015 at KIMS Hospital were included. Primary outcome was mortality rate at 30 days. Seven patients were included in the study (mean age, 58.29±9.8 years). 5 patients had anterior wall myocardial infarction (AWMI) & 2 had inferior wall myocardial infarction (IWMI). None of the patients received thrombolytic therapy. Device was successfully placed in 5 patients (71.4%) with minimal residual shunt in 2 patients (40%). Out of 7 cases 2 patients survived (29% survival rate) and are doing well on follow up at 1 and 5 years respectively. Cardiogenic shock, IWMI and serpigenious form of VSR were associated with poor outcomes. Delayed revascularization (PCI) was associated with better outcomes.
  
  
  CONCLUSIONS
  Percutaneous closure is a potential technique in a selected group of patients. The presence of cardiogenic shock, IWMI and serpigeneous form of VSR constitutes important risk factors for mortality. Device implantation is in general successful with few procedure-related complications and should be applied on a case-by-case basis.
authors.affiliation: Krishna Institute of Medical Sciences, Hyderabad, India. Electronic address: kumarpre@hotmail.com.
authors.forename: Rajendra Kumar
authors.initials: RK
authors.lastname: Premchand
authors.affiliation: Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: Ravikanth
authors.initials: R
authors.lastname: Garipalli
authors.affiliation: Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: T N C
authors.initials: TN
authors.lastname: Padmanabhan
authors.affiliation: Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: Geetesh
authors.initials: G
authors.lastname: Manik
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055989:Septal Occluder Device; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D025321:Surgery, Computer-Assisted / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000150:complications / Q000175:diagnosis / Q000601:surgery*
keywords: Acute Myocardial Infarction (AMI); Cardiogenic Shock(CS); Ventricular Septal Rupture (VSR)