Teo W S, Tong M C, Quek S S, Tan A T, Ong K K
Department of Cardiology, Singapore General Hospital.
Ann Acad Med Singap. 1990 Jan;19(1):15-22.
This is a review of 31 patients with ventricular septal rupture occurring in myocardial infarction which have been managed at the Singapore General Hospital. Ventricular septal rupture occurs more frequently in the elderly, in females and those presenting with the first myocardial infarction. Very few have a prior history of stable angina pectoris before the myocardial infarction. Sudden deterioration as manifested by an increase in heart rate, fall in blood pressure and signs of right heart failure in a patient with acute myocardial infarction (AMI) especially if accompanied by a systolic murmur should encourage a search for a mechanical cause, especially a ventricular septal rupture. 2D echocardiography or Swan-Ganz catheterisation are 100% diagnostic and can be easily and rapidly done at the bedside. Medical management includes vasodilator therapy and inotropic support. Intra-aortic balloon counterpulsation is especially useful and was instituted in 6 patients. Early surgical repair of the ventricular septal defect is important if overall prognosis of these patients is to be improved. Our operative survival of 42.9% is comparable to others, considering that without surgery all have died. Survival appears to be related to the site of the myocardial infarction (very poor prognosis in inferior myocardial infarction), operative treatment (no survivors if treated conservatively) and the mode of presentation (poor prognosis in patients who develop a ventricular septal rupture while in hospital).
这是一篇对新加坡总医院收治的31例心肌梗死并发室间隔破裂患者的综述。室间隔破裂在老年人、女性以及首次发生心肌梗死的患者中更为常见。心肌梗死前很少有稳定型心绞痛的病史。急性心肌梗死（AMI）患者若出现心率加快、血压下降及右心衰竭体征等突然恶化情况，尤其是伴有收缩期杂音时，应考虑寻找机械性病因，特别是室间隔破裂。二维超声心动图或 Swan-Ganz 导管检查诊断率达100%，且可在床边轻松快速完成。药物治疗包括血管扩张剂治疗和正性肌力支持。主动脉内球囊反搏特别有用，6例患者接受了此项治疗。若要改善这些患者的总体预后，早期手术修复室间隔缺损很重要。考虑到未经手术治疗患者均死亡，我们42.9%的手术生存率与其他报道相当。生存率似乎与心肌梗死部位（下壁心肌梗死预后极差）、手术治疗（保守治疗无存活者）及发病方式（住院期间发生室间隔破裂的患者预后较差）有关。
