Left Ventricular Aneurysm and Ventricular Septal Defect Following Myocardial Infarction: A Dangerous Cocktail
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An ischemic ventricular septal defect (VSD) is a lethal complication of myocardial infarction (MI), commonly from 24 hours to up to 5 days of presentation with AMI. Despite the improvement of surgical techniques, the mortality is still very high with poor prognosis. Left ventricular aneurysm (LVA) may also be a fatal mechanical complication of MI but rarely occurs in the posterior or inferior portion of the interventricular septum. Concomitant AMI mechanical complications in the same patient are less than infrequent with poor prognosis, particularly with late hospital arrival.
We present an unusual case of post-myocardial infarction ventricular septal rupture (PI-VSR) combined with left ventricular inferior/inferoseptal aneurysm that was managed surgically.
The aim of this article is to make clinician alerted in case of mechanical complication, especially when post-MI patients become hemodynamically unstable with refractory congestive heart failure.
Fulton MN. Aneurysm of the ventricle of the heart. JAMA. 1941; 116-15.
Madsen JC, Dagget WM., Jr. Repair of post-infarction ventricular septal defects. SeminThoracCardiovasc Surg. 1998; 10: 117-27.
Rashad J B, Ashley E P, Rahul S, Jonathan T, Benjamin H F, et al. Concomitant Left Ventricular Aneurysm and Ventricular Septal Defect Following Acute Inferior Myocardial Infarction from In-Stent Thrombosis in a Post CABG Patient. J Cardiol&CardiovascTher. 2016; 1(4).
Delafield N, Nokes B. Inferior Myocardial Infarction Resulting in Ventricular Septal Rupture and Cardiogenic Shock: A Case Report. Chest Journal. 2017; 152(4).
Deja MA, Szostek J, Widenka K, et al.Port-infarction ventricular septal defect can we do better. Eur J Cardiothorac Surg. 2000; 18(2):194-201
Crenshaw BS, Granger CB, Birmbaum Y, et al, Risk factors, angiographic patterns and outcomes in patients with ventricular septal defect complicating acute myocardial infarction: GUSTO-1 (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation. 2011; 101(1): 27-32.
Menon V, Webb JG, Hillis LD, Sleeper LA, Abboud R, Dzavik V, Slater JN, Forman R, Monrad ES, Talley JD, Hochman JS. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize Occluded Coronaries in cardiogenic shocK? J Am CollCardiol. 2000 Sep; 36(3 Suppl A):1110-6.
Lee WY, Cardon L, SlodkiSJ.Perforation of infarcted interventricularseptum.Report of a case with prolonged survival and review of the literature. Arch Intern Med 1962; 109:731-735.
9.Abuelatta R., Alrashidy T., Taha F, AbdoNaeim H.Concomitant transcatheter closure of post-myocardial infarction ventricular septal defect and inferior wall aneurysm: Case report, European Heart Journal 2020.
Ibanez B James S Agewall S Antunes MJ Bucciarelli-Ducci C Bueno H, et al.
ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology. Eur Heart J 2018; 39:11.
Sui, Yonggang et al. Treatment outcomes and therapeutic evaluations of patients with left ventricular aneurysm. The Journal of international medical research. 2019; 47: 244-51.
Toker ME, Onk OA, Alsalehi S, et al. Posterobasal left ventricular aneurysms: surgical treatment and long-term outcomes. Tex Heart Inst J; 40:424-7.
13.Barker TA, Ramnarine IR, Woo EB, Grayson AD, and Au J. Repair of Post-infarct Ventricular Septal Defect with or without Coronary Artery Bypass Grafting in the Northwest of England. Eur J Cardio-ThoracicSurg; 2003. 24: 940–6.
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