Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese · 2015
Post-infarction ventricular septal defect: risk factors and early outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
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Serpytis Pranas, Karvelyte Neringa, Serpytis Rokas, Kalinauskas Gintaras, Rucinskas Kestutis, Samalavicius Robertas, Ivaska Justinas, Glaveckaite Sigita, Berukstis Egidijus, Tubaro Marco, Alpert Joseph S, Laucevičius Aleksandras
Аннотация
INTRODUCTION: Rupture of the ventricular septum complicates acute myocardial infarction in 0.2% of cases in the thrombolytic era. Ventricular septal defect (VSD) has a mortality of 90-95% in medically managed and 19-60% in surgically treated patients.
METHODS: A retrospective analysis was performed of 41 patients, 26 females (63.4%) and 15 males (36.6%), average age 67.5 ± 15 years, with post-infarction VSD who were treated in the VUL SK intensive cardiology unit between 1991 and 2007.
RESULTS: Thirty-seven patients had hypertension (90.2%); anterior wall acute myocardial infarction (AMI) was found in 27 patients (68%). VSD was more frequent in women than in men (p=0.043). In 36 patients (87%) treatment was started 24 hours or later after the development of AMI symptoms. In 34 patients (83%) the rupture occurred during the first episode of AMI and in the majority of these (19 patients, 46.3%), preoperative coronary angiography demonstrated disease of only one coronary artery. During the first 10 days after the onset of AMI, 5 patients (12.2%) were treated surgically but did not survive the operation; 33 patients (80.5%) underwent operation 3-4 weeks after the onset of AMI and all survived.
CONCLUSIONS: Female sex, advanced age, arterial hypertension, anterior wall AMI, absence of previous AMI, and late arrival at hospital are associated with a higher risk of mortality from acute VSD. The most important factor that determines operative mortality and intra-hospital survival is the time from the onset of AMI to operation.
METHODS: A retrospective analysis was performed of 41 patients, 26 females (63.4%) and 15 males (36.6%), average age 67.5 ± 15 years, with post-infarction VSD who were treated in the VUL SK intensive cardiology unit between 1991 and 2007.
RESULTS: Thirty-seven patients had hypertension (90.2%); anterior wall acute myocardial infarction (AMI) was found in 27 patients (68%). VSD was more frequent in women than in men (p=0.043). In 36 patients (87%) treatment was started 24 hours or later after the development of AMI symptoms. In 34 patients (83%) the rupture occurred during the first episode of AMI and in the majority of these (19 patients, 46.3%), preoperative coronary angiography demonstrated disease of only one coronary artery. During the first 10 days after the onset of AMI, 5 patients (12.2%) were treated surgically but did not survive the operation; 33 patients (80.5%) underwent operation 3-4 weeks after the onset of AMI and all survived.
CONCLUSIONS: Female sex, advanced age, arterial hypertension, anterior wall AMI, absence of previous AMI, and late arrival at hospital are associated with a higher risk of mortality from acute VSD. The most important factor that determines operative mortality and intra-hospital survival is the time from the onset of AMI to operation.
Предметные рубрики MeSH
Age FactorsAgedAged, 80 and overAnterior Wall Myocardial InfarctionCoronary AngiographyFemaleFibrinolytic AgentsHumansHypertensionLithuaniaMaleMiddle AgedOutcome Assessment, Health CareRetrospective StudiesRisk FactorsSex FactorsStreptokinaseSurvival AnalysisThrombolytic TherapyTime-to-TreatmentVentricular Septal Rupture