Interventricular septal rupture after acute myocardial infarction with intermittent opening and closing
Keywords:
myocardial infarction, post-infarction heart rupture, cardiogenic shockAbstract
Ventricular septum rupture is a serious complication in patients with acute myocar-dial infarction. It occurs in approximately 1% of heart attack patients; its mortality rate is high and surgical repair is the treatment of choice. The case of an elderly male patient who was admitted to the Intensive Care Unit for acute anterior myocardial infarction is reported. This patient received thrombolytic therapy with Cuban recom-binant streptokinase and 24 hours later presented hemodynamic deterioration with electrocardiographic changes and appearance of systolic murmur at the apex. Echo-cardiography was performed which showed a ventricular septal defect with inter-mittent opening and closing. Despite treatment, the patient died of circulatory failure hours later. Echocardiographic images and the anatomical specimen are shown. What was unusual in this case was the intermittent opening and closing of the ventricu-
lar septal defect. No similar report was found in the bibliographic databases con-sulted.
Downloads
References
1. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, et al. Heart Disease and Stroke Statistics 2009 Update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009;119:e21-181.
2. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008;29(23): 2909-45.
3. Birnbaum Y, Fishbein MC, Blanche C, Siegel RJ. Ventricular septal rupture after acute myocardial infarction. N Engl J Med. 2002;347(18):1426-32.
4. Crenshaw B, Granger C, Birnbaum Y, Pieper K, Morris DC, Kleiman NS, 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 Arte-ries) trial investigators. Circulation. 2000:101(1):27-32.
5. 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(1):33-42.
6. Jones MT, Schofield PM, Dark JF, Moussalli H, Deiraniya AK, Lawson RA, et al. Surgical repair of acquired ventricular septal defect. Determinants of early and late outcome. J Thorac Cardiovasc Surg. 1987;93(5):680-6.
7. Curcio A, Martín J, Wilhelmi M, Soria JL. Doble com-plicación postinfarto agudo de miocardio: rotura del septo interventricular e insuficiencia mitral aguda. Rev Esp Cardiol. 1997;50(2):129-32.
8. Gregoric ID, Bieniarz MC, Arora H, Frazier OH, Kar B, Loyalka P. Percutaneous ventricular assist device support in a patient with a postinfarction ventri-cular septal defect. Tex Heart Inst J. 2008;35(1):46-9.
9. Williams RI, Ramsey MW. Spontaneous closure of an acquired ventricular septal defect. Postgrad Med J. 2002;78(921):425-6.
10. Coskun KO, Coskun ST, Popov AF, Hinz J, Schmitto JD, Bockhorst K, et al. Experiences with surgical treatment of ventricle septal defect as a post in-farction complication. J Cardiothorac Surg. 2009; 4:3. Disponible en: http://www.cardiothoracicsurgery.org/content/4/1/3
11. Kerr F, Haywood LJ. Electrocardiographic changes produced by interventricular septal rupture. Br Heart J. 1976;38(10):1098-100.
12. Soriano CJ, Pérez-Boscá JL, Canovas S, Ridocci F, Federico P, Echanove I, et al. Septal rupture with right ventricular wall dissection after myocardial infarction. Cardiovasc Ultrasound. 2005;3:33. Disponible en: http://www.cardiovascularultrasound.com/content/3/1/33
13. Ghersin E, Lessick J, Abadi S, Agmon Y, Adler Z, Engel A, et al. Ventricular septal rupture com-plicating myocardial infarction: comprehensive assessment of cardiac coronary arteries, anatomy, perfusion and function by multidetector computed tomography. Can J Cardiol. 2008;24(3):e21-2.
14 . Vogel-Claussen J, Skrok J, Fishman EK, Lima JA, Shah AS, Bluemke DA. Cardiac CT and MRI guide surgery in impending left ventricular rupture after acute myocardial infarction. J Cardiothorac Surg. 2009;4:42. Disponible en: http://www.biomedcentral.com/content/pdf/1749-8090-4-42.pdf
15. Fazlinezhad A, Rezaeian MK, Yousefzadeh H, Ghaffarzadegan K, Khajedaluee M. Plasma Brain Natriuretic Peptide (BNP) as an Indicator of Left Ventricular Function, Early Outcome and Mechanical Complications after Acute Myocardial Infarc-tion. Clin Med Insights Cardiol. 2011;5:77-83.
Downloads
Published
How to Cite
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
