Maladies cardiovasculaires et diagnostic

A Study of Post Myocardial Infarction Ventricular Septal Rupture (MI VSR) and its Outcomes - A Single Centre Experience

Abstract

Suresh Patted, Metgudmath, , Prasad MR, , Suhasini Atharga, , Vaibhav Patil, , Vishwanath Hesarur, , Sanjay Porwal, Sameer Ambar, and Dhulipalla Dharma Teja

Objective: Post myocardial infarction (MI) the ventricular septal rupture (VSR), a fatal complication is associated with higher incidences of morality. The main objective of this study is to explore the correlation between the timing of intervention and clinical outcome (mortality), and to identify the risk factors affecting the outcome in MI VSR patients.

Methods: In this retrospective study, 48 patients diagnosed to have post MI VSR admitted to the Departments of Cardiology and Cardiovascular thoracic surgery at KLES Dr. Prabhakar Kore Hospital, Belagavi were analysed. The primary outcome was mortality and the effect of different treatment modalities, management of MI VSR and influence of intervention time on mortality was explored..

Results: Among 48 patients, mortality was 41.2% in 17 patients who received patch closure and 63% in 27 patients who received patch with additional CABG; however, the difference was not statistically different. Further, mortality rate was 54% despite the surgical interventions and between the non-survivor and survivor group mortality was significantly higher in patients with older age (64.77 ± 8.04 years vs. 54.64 ± 14.575, p<0.01) and with shorter duration of ‘time from AMI to VSR’ (2.95±3.51 days vs. 5±3.51 days, p<0.05). Post-operative complications such as renal failure (χ²=4.273, p<0.05) and sepsis (χ²=10.688, p<0.01) was significantly different between the two groups with higher occurrence in nonsurvivor group. The management of MI VSR using thrombolytic therapy, preoperative IABP and ECMO had no significant effect on the outcome.

Conclusion: The shorter duration of time from AMI to VSR predicted mortality, and shorter interval of CABG time and ACCT was effective in the survival of patients. Further, this study indicates that risk factors predisposing patients to mortality also includes post-operative renal failure and sepsis.