Ischemic Ventricular Septal Defect: Two Rare Cases
Published: 2022-12-02
Page: 332-336
Issue: 2022 - Volume 5 [Issue 1]
S. Abouradi *
Cardiology Department, Ibn Rochd Hospital University, Morocco.
H. Choukrani
Cardiology Department, Ibn Rochd Hospital University, Morocco.
K. Chawki
Cardiology Department, Ibn Rochd Hospital University, Morocco.
S. Arous
Cardiology Department, Ibn Rochd Hospital University, Morocco.
G. Benouna
Cardiology Department, Ibn Rochd Hospital University, Morocco.
R. Habbal
Cardiology Department, Ibn Rochd Hospital University, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Interventricular septal rupture occurring in the acute phase of a myocardial infarction is a rare complication, its incidence varies between 1 and 2%. We present the observation of two patients with myocardial infarction complicated by apical rupture of the interventricular septum.
Cases:
Case 1: We report a 56 years old female with a history of hypertension and diabetes mellitus admitted to our intensive care unit for a ST-Segment–Elevation Acute Coronary Syndrome treated with thrombolysis complicated with heart failure the patient presented a hemodynamic instability requiring the introduction of vasoactive drugs. We performed an echocardiography that showed a solution of continuity of the interventricular septum.
Case 2: We report a 88 years old active male smoker admitted to our intensive care unit for an anterior ST segment elevation acute coronary syndrome treated with thrombolysis. On the 2nd day of hospitalization, the patient presented a supra-ventricular tachycardia at 160bpm, an echocardiography was then realized which objectified a solution of continuity in the apical segment of the inter ventricular septum.
Conclusion: Ischemic ventricular defect is a rare, serious, and major mechanical complication of myocardial infarction. The best treatment is still surgery despite its high morbidity and mortality rate in the postoperative period.
Keywords: Coronary artery disease, myocardial infarction, ischemic septal defect
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References
Walts PA, Gillinov AM. Survival after simultaneous left ventricular free wall, papillary muscle, and ventricular septal rupture. Ann Thorac Surg. 2004;78(5):e77 –78.
Braunwald E, Zipes DP, Libby P. Acute myocardial infarction. In: Antman EM, Braunwald E, editors. Heart disease, a text book of cardiovascular medicine. 6e éd. Philadelphia: WB Saunders. 2001:1114–218.
Hackel DB, Wagner GS. Acute myocardial infarction with papillary muscle rupture. Clin Cardiol. 1993;16(1):59–64.
Cummings RG, Califf R, Jones RN, Reimer KA, Kong YH, Lowe JE. Correlates of survival in patients with post infarction ventricular septal defect. Ann Thorac Surg. 1989;47(6):824–830
Crenshaw BS, Granger CB, Birnbaum Y, et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation. 2000;101:27-32.
Yip HK, Fang CY, Tsai KT, et al. The potential impact of primary percutaneous coronary intervention on ventricular septal rupture complicating acute myocardial infarction. Chest. 2004;125:1622-1628.
Poulsen SH, Praestholm M, Munk K, Wierup P, Egeblad H, Nielsen-Kudsk JE. Ventricular septal rupture complicating acute myocardial infarction: Clinical characteristics and contemporary outcome. Ann Thorac Surg. 2008;85:1591-1596.
Becker RC, Gore JM, Lambrew C, Weaver WD, Rubinson RM, French WJ, Tiefenbrunn AJ, Bowlby LJ, Rogers WJ. For the National Registry of Myocardial Infarction participants. A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction. J Am Coll Cardiol.1996 ;27:1321–1326.
Cummings RG, Reimer KA, Califf R, Hackel D, Boswick J, Lowe JE. Quantitative analysis of right and left ventricular infarction in the presence of postinfarction ventricular septal defect. Circulation.1988;77:33–42.
Edwards SB, Edwards WD, Edwards JE. Ventricular septal rupture complicating acute myocardial infarction: Identification of simple and complex types in 53 autopsied hearts. Am J Cardiol. 1984; 54:1201–1205.
Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS, et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. Circulation. 2000;101(1):27– 32.
Mantovani V, Mariscalco G, Leva C, Blanzola C, Sala A. Surgical repair of post-infarction ventricular septal defect: 19 years of experience. Int. J Cardiol. 2006; 108:202-206.
Alexandre Cinq-Mars, Pierre Voisine, François Dagenais, Risk factors of mortality after surgical correction of ventricular septal defect following myocardial infarction: Retrospective analysis and review of the literature. International Journal of Cardiology. 2016;206:27-36.