Sagar Pramod, Chikkala Raghuram, Suthan Sridhara, Nasser Aayisha, Sivakumar Kothandam, Sethuratnam Rajan, Kurian Valikapthalil Mathew, Ajit Mullasari Sankardas
Madras medical Mission, Department of Pediatric cardiology, Chennai, India.
Madras medical Mission, Department of Pediatric cardiology, Chennai, India.
Indian Heart J. 2025 May-Jun;77(3):151-158. doi: 10.1016/j.ihj.2025.05.002. Epub 2025 May 5.
Post myocardial infarction ventricular septal rupture (MI-VSR) is a devastating complication after acute myocardial infarction (AMI); lacks uniform treatment recommendations and carries poor outcomes.
To evaluate the outcomes of post MI-VSR, stratify based on management strategy and determine the predictors of survival.
All cases of VSR hospitalized in a tertiary referral cardiac care center over 11 years were retrospectively evaluated for various parameters and stratified based on the modality of treatment, either conservative, surgical or transcatheter closure.
Among a total of 131 cases of VSR with a median age of 65 years, hospitalized from January 2013 to December 2023, 47(35.9 %) had surgical closure, 25(19.1 %) had transcatheter closure and the rest were managed conservatively. 11(8.4 %) cases alone underwent primary percutaneous coronary intervention (PCI). Apex was the commonest (79.3 %) site. Older patients and patients in higher stages of shock at the time of VSR diagnosis were often managed conservatively. Two-thirds of surgical patients were in SHOCK stage A or B; three-fourths of transcatheter group were in stage C or D. Overall mortality was 71 % with 100 % in conservative, 68 % in transcatheter closure and 36.2 % in surgical group. Younger age, lower shock stage, VSR closure, and delayed closure were predictors of survival.
Post MI VSR outcomes were poor, based on the hemodynamic status. Closure of VSR is essential for survival. Surgical closure had lower mortality than transcatheter closure possibly contributed by a selection bias.
心肌梗死后室间隔破裂（MI-VSR）是急性心肌梗死（AMI）后一种严重的并发症；缺乏统一的治疗建议且预后较差。
评估MI-VSR的预后，根据管理策略进行分层并确定生存的预测因素。
对一家三级转诊心脏护理中心11年间收治的所有VSR病例进行回顾性评估，分析各种参数，并根据治疗方式（保守治疗、手术治疗或经导管封堵）进行分层。
在2013年1月至2023年12月住院的131例VSR病例中，中位年龄为65岁，47例（35.9%）接受了手术封堵，25例（19.1%）接受了经导管封堵，其余接受保守治疗。仅11例（8.4%）患者接受了直接经皮冠状动脉介入治疗（PCI）。心尖是最常见的部位（79.3%）。年龄较大的患者以及VSR诊断时处于休克较高阶段的患者通常接受保守治疗。三分之二的手术患者处于休克A或B阶段；四分之三的经导管治疗组患者处于C或D阶段。总体死亡率为71%，保守治疗组为100%，经导管封堵组为68%，手术组为36.2%。年龄较小、休克阶段较低、VSR封堵以及延迟封堵是生存的预测因素。
基于血流动力学状态，MI-VSR的预后较差。VSR封堵是生存的关键。手术封堵的死亡率低于经导管封堵，这可能是由选择偏倚导致的。
