Ferraioli Donatella, Santoro Giuseppe, Bellino Michele, Citro Rodolfo
Heart Department, University Hospital "S.Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy.
Pediatric Cardiology and GUCH Unit, Fondazione Toscana CNR -G.Monasterio, Massa, Italy.
J Cardiovasc Echogr. 2019 Jan-Mar;29(1):17-19. doi: 10.4103/jcecho.jcecho_60_18.
Ventricular septal defect (VSD) is one of the most serious mechanical complications of acute myocardial infarction (AMI). Despite the incidence of post-AMI VSD in reperfusion era has reduced from 1%-2% to 0.17%-0.31%, it is a still life-threatening condition with poor prognosis. Surgical VSD closure is considered the best treatment approach since conservative management carries an extremely high mortality rate. Over the last decade, percutaneous transcatheter closure has emerged as an alternative therapeutic strategy for a patient with post-AMI VSD, with outcomes similar to cardiac surgery (30-day mortality 14%-66%). We present a case of inferior AMI complicated by posterobasal VSD and cardiogenic shock successfully treated with percutaneous closure. The role of echocardiography in diagnosis, management, and percutaneous procedure guiding has been emphasized.
室间隔缺损(VSD)是急性心肌梗死(AMI)最严重的机械性并发症之一。尽管在再灌注时代,急性心肌梗死后室间隔缺损的发生率已从1%-2%降至0.17%-0.31%,但它仍是一种危及生命的疾病,预后较差。由于保守治疗的死亡率极高,手术闭合室间隔缺损被认为是最佳治疗方法。在过去十年中,经皮导管闭合术已成为急性心肌梗死后室间隔缺损患者的一种替代治疗策略,其结果与心脏手术相似(30天死亡率为14%-66%)。我们报告一例下壁急性心肌梗死合并后基底室间隔缺损及心源性休克患者经皮闭合术成功治疗的病例。强调了超声心动图在诊断、管理和经皮手术指导中的作用。