Xu Xu-Dong, Liu Su-Xuan, Liu Xin, Chen Yan, Li Ling, Qu Bai-Ming, Wu Zhi-Yong, Zhang Dai-Fu, Zhao Xian-Xian, Qin Yong-Wen
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China.
Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou 450008, PR China.
J Cardiol. 2014 Oct;64(4):285-9. doi: 10.1016/j.jjcc.2014.02.006. Epub 2014 Mar 24.
Surgical repair is an effective method to treat ventricular septal defect (VSD) complicating acute myocardial infarction (AMI). However, the mortality rate remains high. This study was designed to assess the immediate and mid-term results of transcatheter closure of postinfarct muscular VSDs.
Data were retrospectively collected from 42 AMI patients who underwent attempted transcatheter VSD closure between 2008 and 2012 in seven heart centers of China.
Nine patients underwent emergent VSD closure in the acute phase (within two weeks from VSD) while the others underwent elective closure. The time between VSD occurrence and closure in emergency group and elective group was 7.7 ± 2.3 days and 35 ± 14.5 days, respectively (p<0.01). The percentage of procedure success in the emergency group and elective group was 77.8% (7/9) and 97% (32/33), respectively (p=0.048). The hospital mortality was higher for emergent closure in comparison to elective closure (66.7% vs. 6.1%, p<0.01). During a median follow-up of 25 months (0-58 months), two patients died at 8 and 29 months, respectively, and no serious complications occurred in other patients.
Interventional postinfarct VSD closure is a safe and effective approach that can be performed with a high procedural success rate, with favorable outcomes if it can be undertaken >14 days postinfarct.
手术修复是治疗合并急性心肌梗死（AMI）的室间隔缺损（VSD）的有效方法。然而，死亡率仍然很高。本研究旨在评估经导管封堵梗死心肌后室间隔缺损的近期和中期结果。
回顾性收集2008年至2012年在中国七个心脏中心接受经导管室间隔缺损封堵术的42例急性心肌梗死患者的数据。
9例患者在急性期（室间隔缺损发生后两周内）进行了急诊室间隔缺损封堵术，其余患者进行了择期封堵术。急诊组和择期组室间隔缺损发生至封堵的时间分别为7.7±2.3天和35±14.5天（p<0.01）。急诊组和择期组手术成功率分别为77.8%（7/9）和97%（32/33）（p=0.048）。与择期封堵相比，急诊封堵的院内死亡率更高（66.7%对6.1%，p<0.01）。在中位随访25个月（0-58个月）期间，分别有2例患者在8个月和29个月时死亡，其他患者未发生严重并发症。
介入性梗死心肌后室间隔缺损封堵术是一种安全有效的方法，手术成功率高，如果在心肌梗死后>14天进行，预后良好。
