Management of post-myocardial infarction ventricular septal defects: A critical assessment

Sabry Omar, Garrison L. Morgan, Hemang B. Panchal, Vinod Thourani, Charanjit Rihal, Ruchi Patel, Nisharahmed Kherada, Alexander Egbe, Nirat Beohar

Research output: Contribution to journalReview article

4 Scopus citations

Abstract

Background: Post-myocardial infarction (MI) ventricular septal defects (PIVSD) are an uncommon but life-threatening complication of acute MI. Although surgical closure has been the standard of care, mortality, and recurrence of VSD remain high even after emergent surgery. Transcatheter VSD closure (TCC) devices have become an alternative or adjunct to surgical closure. Methods: Online database search was performed for studies that included adults with PIVSD who underwent medical treatment (MT) alone, surgical closure (SC) (early or late), and TCC (early, late, or for post-surgical residual VSD). Results: Twenty-six studies were included with a total of 737 patients who underwent either MT (N = 100), SC (early (n = 167), late (n = 100)), and TCC (early (n = 176), late (n = 115), or post-surgical residual VSD (n = 79)). The 30-day mortality among MT group was 92 ± 6.3%, among SC was 61 ± 22.5% (early 56 ± 23%, late 41 ± 30%), and for all TCC patients was 33 ± 24% (early 54 ± 32.7%, late 16 ± 26%), and TCC for post-surgical residual VSD 11 ± 34.9%. The mortality among overall SC, overall TCC and early TCC groups was significantly lower as compared with the MT (P < 0.001 for all comparisons). The overall mortality among all TCC, and late TCC groups was significantly lower when compared with the late SC (P < 0.0001, P < 0.0001, respectively). Conclusion: Closure of PIVSD decreases mortality as compared with MT alone and should be attempted as early as possible after diagnosis. Selection of TCC versus SC should be based on factors including complexity of the defect, availability of closure devices, expertise of the operator, and clinical condition of patient.

Original languageEnglish (US)
Pages (from-to)939-948
Number of pages10
JournalJournal of Interventional Cardiology
Volume31
Issue number6
DOIs
StatePublished - Dec 1 2018

Keywords

  • closure device
  • management
  • post-infarction VSD
  • transcatheter

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Management of post-myocardial infarction ventricular septal defects: A critical assessment'. Together they form a unique fingerprint.

  • Cite this

    Omar, S., Morgan, G. L., Panchal, H. B., Thourani, V., Rihal, C., Patel, R., Kherada, N., Egbe, A., & Beohar, N. (2018). Management of post-myocardial infarction ventricular septal defects: A critical assessment. Journal of Interventional Cardiology, 31(6), 939-948. https://doi.org/10.1111/joic.12556