Kharge Jayashree, Parikh Chirag Jagdish, Suranagi Manohar Jayadevappa, Lakshmanasastry Sridhar, Srinivasa Kikkeri Hemanasetty, Manjunath Cholanahalli Nanjappa
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
Am Heart J Plus. 2022 Feb 7;13:100095. doi: 10.1016/j.ahjo.2022.100095. eCollection 2022 Jan.
Ventricular septal rupture (VSR), a mechanical complication of myocardial infarction (MI), usually presents with rapid clinical deterioration with acute heart failure or cardiogenic shock. VSR may occur within 24 h to several days after MI and can occur in both anterior and inferior wall MI. Although guidelines recommend emergent surgery, this is associated with a high mortality rate of up to 40%. Intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) stabilize patients in preparation for angiography and surgery. Delayed surgery allows better septal repair in scarring tissue but also carries the risk of rupture extension and death while waiting. Percutaneous closure of the defect with appropriately designed devices results in better survival in the subacute phase.
To study the indicators and predictors of VSR in the current era of primary percutaneous coronary interventions and mechanical circulatory support.
Of total of 34,681 patients presenting with MI, the incidence of VSR was 0.45%. We sought to evaluate the predictors of survival and death in VSR. Coronary angiography (CAG) was performed, hemodynamic support provided to unstable patients, and consenting patients were referred to definitive therapy, either surgery or percutaneous device closure. The previously postulated hypotheses of triple vessel disease (TVD), diabetes mellitus (DM), and concentric left ventricular hypertrophy (LVH) due to Hypertension (HTN) being protective against VSR were explored.
Of the 169 patients with VSR, we found that the group that survived was mostly men and the mean age was 61.5 years; this was in contrast to the non-survivors, who were mainly women, and the mean age was 65.2 years ( = 0.025); higher Killip Class was 111-1V ( = 0.001), lower LVEF ( = 0.010), apical VSR and LV aneurysm ( = 0.015 and = 0.002, respectively) were predictors of death. 48 patients underwent CAG, with single vessel disease (SVD) with lower-grade Rentrop collateral flow being most common in the death group. 25 patients were subjected to definitive therapy with surgical patch closure or percutaneous device closure. The patients who died were older by approximately 7 years. The risk factors for coronary artery disease, such as HTN, diabetes, and smoking, were not statistically different between the two groups.
Prevention of myocardial infarction is more important than managing a VSR, which carries a high mortality despite advanced mechanical support and definitive interventional therapy such as emergent surgery and percutaneous device closure.
室间隔破裂（VSR）是心肌梗死（MI）的一种机械性并发症，通常表现为急性心力衰竭或心源性休克导致的临床快速恶化。VSR可在MI后24小时至数天内发生，可发生于前壁和下壁MI。尽管指南推荐紧急手术，但这与高达40%的高死亡率相关。主动脉内球囊泵（IABP）和体外膜肺氧合（ECMO）可稳定患者病情，为血管造影和手术做准备。延迟手术可在瘢痕组织中更好地修复室间隔，但等待期间也有破裂扩展和死亡的风险。使用设计合适的装置经皮闭合缺损可使亚急性期生存率更高。
研究在当前初级经皮冠状动脉介入治疗和机械循环支持时代VSR的指标和预测因素。
在总共34681例MI患者中，VSR的发生率为0.45%。我们试图评估VSR患者生存和死亡的预测因素。进行冠状动脉造影（CAG），为不稳定患者提供血流动力学支持，同意治疗的患者接受确定性治疗，即手术或经皮装置闭合。探讨先前假设的三支血管病变（TVD）、糖尿病（DM）以及高血压（HTN）导致的同心性左心室肥厚（LVH）对VSR具有保护作用的假说。
在169例VSR患者中，我们发现存活组大多为男性，平均年龄为61.5岁；这与非存活组相反，非存活组主要为女性，平均年龄为65.2岁（P = 0.025）；较高的Killip分级为Ⅲ-Ⅳ级（P = 0.001）、较低的左心室射血分数（LVEF）（P = 0.010）、心尖部VSR和左心室室壁瘤（分别为P = 0.015和P = 0.002）是死亡的预测因素。48例患者接受了CAG，单支血管病变（SVD）且Rentrop侧支血流分级较低在死亡组最为常见。25例患者接受了手术补片闭合或经皮装置闭合的确定性治疗。死亡患者年龄约大7岁。两组之间冠状动脉疾病的危险因素，如HTN、糖尿病和吸烟，在统计学上无差异。
预防心肌梗死比处理VSR更重要，尽管有先进的机械支持和紧急手术及经皮装置闭合等确定性介入治疗，但VSR的死亡率仍很高。
