Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2021 Apr;25(8):3296-3299. doi: 10.26355/eurrev_202104_25739.
Ventricular septal defect (VSD) is an uncommon but frequently fatal complication following acute myocardial infarction. In medically treated patients, mortality rates exceed 90%, while the surgical repair is associated with better outcomes, even though optimal surgical timing is still under debate.
We present the case of a 78-years-old man with no previous remarkable cardiological history admitted to our Emergency Department with the diagnosis of anterior ST-elevation myocardial infarction and significant reduction of left ventricular ejection fraction. The emergency coronary angiography showed sub-occlusion of the left anterior descending coronary artery, treated with stent implantation. The post-procedural echocardiography unveiled the presence of an apical VSD with a large left-to-right shunt, significant right ventricular overload and dysfunction. An intra-aortic balloon pump (IABP) was positioned and, after Heart Team evaluation, a delayed surgical approach was planned. As a bridge to the intervention Levosimendan infusion was administered, on top of IABP support, and a significant improvement in bi-ventricular function and pressure profiles was obtained. Cardiac surgery was successfully performed 9 days after the admission without periprocedural complications.
This unique case supports the use of Levosimendan as a valid pharmacological strategy for perioperative management of VSD.
室间隔缺损（VSD）是急性心肌梗死后一种罕见但常致命的并发症。在接受药物治疗的患者中，死亡率超过 90%，而手术修复则与更好的预后相关，尽管最佳手术时机仍存在争议。
我们报告了一例 78 岁男性病例，无明显既往心脏病史，因前壁 ST 段抬高型心肌梗死和左心室射血分数显著降低而收入我院急诊科。紧急冠状动脉造影显示左前降支次全闭塞，采用支架植入术治疗。术后超声心动图显示存在顶部 VSD，伴有大量左向右分流、右心室负荷和功能显著增加。置入主动脉内球囊泵（IABP），经心脏团队评估后，计划延迟手术。在 IABP 支持的基础上，给予左西孟旦输注作为桥接治疗，从而获得双心室功能和压力曲线的显著改善。心脏手术后 9 天成功进行，无围手术期并发症。
本独特病例支持将左西孟旦用作 VSD 围手术期管理的有效药物治疗策略。
