Postinfarction Ventricular Septal Defects: Towards a New Treatment Algorithm?

Simon Maltais, Reda Ibrahim, Arsène Joseph Basmadjian, Michel Carrier, Denis Bouchard, Raymond Cartier, Philippe Demers, Martin Ladouceur, Michel Pellerin, Louis P. Perrault

Research output: Contribution to journalArticle

64 Scopus citations

Abstract

Background: We reviewed our experience at the Montreal Heart Institute with early surgical and percutaneous closure of postinfarction ventricular septal defects (VSD). Methods: Between May 1995 and November 2007, 51 patients with postinfarction VSD were treated. Thirty-nine patients underwent operations, and 12 were treated with percutaneous closure of the VSD. Results: Half of the patients were in systemic shock, and 88% were supported with an intraaortic balloon pump before the procedure. Before the procedure, 14% of patients underwent primary percutaneous transluminal coronary angioplasty. The mean left ventricular ejection fraction was 0.44 ± 0.11, and mean Qp/Qs was 2.3 ± 1. Time from acute myocardial infarction to VSD diagnosis was 5.4 ± 5.1 days, and the mean delay from VSD diagnosis to treatment was 4.0 ± 4.0 days. A moderate to large residual VSD was present in 10% of patients after correction. Early overall mortality was 33%. Residual VSD, time from myocardial infarction to VSD diagnosis, and time from VSD diagnosis to treatment were the strongest predictor of mortality. Twelve patients were treated with a percutaneous occluder device, and the hospital or 30-day mortality in this group was 42%. Conclusion: Small or medium VSDs can be treated definitively with a ventricular septal occluder or initially to stabilize patients and allow myocardial fibrosis, thus facilitating delayed subsequent surgical correction.

Original languageEnglish (US)
Pages (from-to)687-692
Number of pages6
JournalAnnals of Thoracic Surgery
Volume87
Issue number3
DOIs
StatePublished - Mar 2009

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Maltais, S., Ibrahim, R., Basmadjian, A. J., Carrier, M., Bouchard, D., Cartier, R., Demers, P., Ladouceur, M., Pellerin, M., & Perrault, L. P. (2009). Postinfarction Ventricular Septal Defects: Towards a New Treatment Algorithm? Annals of Thoracic Surgery, 87(3), 687-692. https://doi.org/10.1016/j.athoracsur.2008.11.052