Serpytis Pranas, Karvelyte Neringa, Serpytis Rokas, Kalinauskas Gintaras, Rucinskas Kestutis, Samalavicius Robertas, Ivaska Justinas, Glaveckaite Sigita, Berukstis Egidijus, Tubaro Marco, Alpert Joseph S, Laucevičius Aleksandras
Cardiology and Angiology Center, Vilnius University, Vilnius, Lithuania.
Hellenic J Cardiol. 2015 Jan-Feb;56(1):66-71.
Rupture of the ventricular septum complicates acute myocardial infarction in 0.2% of cases in the thrombolytic era. Ventricular septal defect (VSD) has a mortality of 90-95% in medically managed and 19-60% in surgically treated patients.
A retrospective analysis was performed of 41 patients, 26 females (63.4%) and 15 males (36.6%), average age 67.5 ± 15 years, with post-infarction VSD who were treated in the VUL SK intensive cardiology unit between 1991 and 2007.
Thirty-seven patients had hypertension (90.2%); anterior wall acute myocardial infarction (AMI) was found in 27 patients (68%). VSD was more frequent in women than in men (p=0.043). In 36 patients (87%) treatment was started 24 hours or later after the development of AMI symptoms. In 34 patients (83%) the rupture occurred during the first episode of AMI and in the majority of these (19 patients, 46.3%), preoperative coronary angiography demonstrated disease of only one coronary artery. During the first 10 days after the onset of AMI, 5 patients (12.2%) were treated surgically but did not survive the operation; 33 patients (80.5%) underwent operation 3-4 weeks after the onset of AMI and all survived.
Female sex, advanced age, arterial hypertension, anterior wall AMI, absence of previous AMI, and late arrival at hospital are associated with a higher risk of mortality from acute VSD. The most important factor that determines operative mortality and intra-hospital survival is the time from the onset of AMI to operation.
在溶栓治疗时代，室间隔破裂使0.2%的急性心肌梗死病例病情复杂化。室间隔缺损（VSD）在接受药物治疗的患者中的死亡率为90 - 95%，在接受手术治疗的患者中为19 - 60%。
对1991年至2007年期间在VUL SK强化心脏病科接受治疗的41例心肌梗死后室间隔缺损患者进行回顾性分析，其中女性26例（63.4%），男性15例（36.6%），平均年龄67.5±15岁。
37例患者患有高血压（90.2%）；27例患者（68%）出现前壁急性心肌梗死（AMI）。女性室间隔缺损的发生率高于男性（p = 0.043）。36例患者（87%）在AMI症状出现后24小时或更晚开始治疗。34例患者（83%）在首次AMI发作期间发生破裂，其中大多数（19例，46.3%）术前冠状动脉造影显示仅一支冠状动脉病变。在AMI发作后的前10天内，5例患者（12.2%）接受了手术治疗，但手术未能存活；33例患者（80.5%）在AMI发作后3 - 4周接受手术，全部存活。
女性、高龄、动脉高血压、前壁AMI、既往无AMI以及就医延迟与急性室间隔缺损的较高死亡风险相关。决定手术死亡率和院内生存率的最重要因素是从AMI发作到手术的时间。
