Postinfarction Ventricular Septal Defects: Towards a New Treatment Algorithm?

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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 1 2009
Externally publishedYes

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Postinfarction Ventricular Septal Defects : Towards a New Treatment Algorithm? / Maltais, Simon; Ibrahim, Reda; Basmadjian, Arsène Joseph; Carrier, Michel; Bouchard, Denis; Cartier, Raymond; Demers, Philippe; Ladouceur, Martin; Pellerin, Michel; Perrault, Louis P.

In: Annals of Thoracic Surgery, Vol. 87, No. 3, 01.03.2009, p. 687-692.

Research output: Contribution to journalArticle